INDIVIDUALISED OVARIAN STIMULATION PROTOCOLS
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This document discusses individualized controlled ovarian stimulation (I COS) protocols. It notes that conventional approaches use long agonist protocols with standard gonadotropin doses based on age. I COS allows for personalization based on ovarian reserve tests, biomarkers, and other factors to customize stimulation aims at moderate oocyte retrieval while increasing clinical pregnancy rates. Prediction models can be used to determine starting doses, protocols, and adjuvants based on a patient's ovarian response classification as poor, normal, or hyper responders.
INDIVIDUALISED OVARIAN STIMULATION PROTOCOLS
- 2. Dr Shweta Kaul jha M.S.,FNB,FNAMS. Board Certified( National Board of Examination,New Delhi) Journey has just begun..
- 4. LIVE BIRTH COST EFFECTIVE PATIENT FRIENDLY
- 5. CONVENTIONAL APPROACH LONG AGONIST PROTOCOL WITH STANDARD AGE DEFINED DOSES OF GONADOTROPHINS.
- 12. INDIVIDUALISED CONTROLLED OVARIAN PROTOCOLS (I COS)
- 13. Personalised care,Variability in ovarian response,Customised with aim at moderate oocyte numbers (10-15) and increased CPR and not no.of eggs .
- 14. Our aim-
- 17. HOW IS IT POSSIBLE NOW?
- 18. Newer Drugs and technologies Bye Bye Urinary gonadotrophins Recombinant Gonadotrophins filled by mass FBM. Embryo culture/Selection better. Vitrification vs slow freezing
- 19. HOW TO INDIVIDUALISE AND WHAT TO INDIVIDUALISE?
- 21. PREDICTION BASED ON ORT BUT Response is not equivalent to reserve Depending on Ovarian Reserve Tests we predicted Poor/normal and hyper responders
- 22. FUTURE Prediction of Ovarian response -Based on Age Hormonal markers Functional markers Genetic markers BMI Ethinicity Cause of infertility
- 23. AGE
- 25. Best available marker-AMH for predicting number of oocyte but not to exclude from treatment. Less AMH does not mean less pregnancy.
- 28. Functional biomarkers Antral follicle count AFC (2-10 mm) day 2 predicts reserve/response AFC RESPONSE <8 POOR 8-10 LOW NORMAL 11-15 NORMAL > 15 HYPER
- 29. WHAT WENT WRONG?
- 31. SINGLE NUCLEOTIDE PROTEIN In position 680 of FSH receptor is associated with altered response to stimulation. LH receptor mutation-may require LH supplementation.
- 32. PHARMACOGENETIC MODEL-MADE BY RECOGNISING GENETIC MARKERS.
- 33. OTHER CAUSES-BMI
- 34. ETHNICITY
- 38. INDIVIDUALISE STARTING DOSE PROTOCOL ADJUVANTS TRIGGER
- 39. RESPONSE PREDICTION BASED TAILORING PATIENT TYPE OPTION AVAILABLE POOR RESPONDER ANDROGEN PRETREATMENT ,GROWTH HORMONE,FLARE/ANTAG ONIST/SHORT NORMAL ANTAG/ AGONIST HYPER RESPONDER METFORMIN,AGONIST TRIGGER ,FREEZE,DOPAMINE
- 42. Multivariate predictive models. Valid in different poulations Simple to use in day to day practise Predictor models based on genetic markers