3. 16 follicles 12 mature oocytes 14 oocytes Extras frozen if good 2 to 3 transferred 9 fertilize normally 5 divide normally 30-40% of couples 4 stop dividing & sperm Typical progression
4. OHSS is a serious complication of ovulation induction. In its severest forms, it is complicated by hemoconcentration, venous thrombosis, electrolyte imbalance and renal and hepatic failure. Shenker and Weinstein, 1978; Navot et al., 1992; Aboulghar et al., 1993
21. COCHRANE REVIEW, D’ANGELO E.AL. 2010 Coasting vs. no coasting
22.
23. GnRH antagonist In a Cochrane review by Al-Inany et al (2011) comparing agonist and antagonist, significant difference in the incidence of OHSS was found.
31. OUR RESULTS Parameter Coasting (n = 96) Antagonist (n = 94) P-value Age (years) 30.0 ± 4.9 29.6 ± 4.6 NS Duration of infertility (years) 6.64 ± 4.45 7.07 ± 4.3 NS No. of HMG injections 30.52 ± 8.9 29.94 ± 8.8 NS Days of stimulation 1 9.1 ± 1.5 9.4 ± 1.5 NS Peak oestradiol (pg/ml) 5087 ± 1589 5305 ± 1680 NS Oestradiol on day of HCG (pg/ml) 2605 ± 790 2721 ± 699 NS Range of oestradiol on day of HCG (pg/ml) 1110–4136 1223–4093 NS Day of intervention 2.82 ± 0.97 1.74 ± 0.91 <0.0001 No. of oocytes 14.06 ± 5.20 16.5 ± 7.60 0.02 No. of MII oocytes 11.13 ± 4.60 13.14 ± 6.60 NS No. of fertilized oocytes 7.97 ± 3.80 9.14 ± 4.70 NS No. of high quality embryos 2.21 ± 1.10 2.87 ± 1.20 0.0001 No. of embryos transferred 2.83 ± 0.50 2.79 ± 0.40 NS No. of cryopreserved embryos 4.50 ± 3.93 5.77 ± 4.87 NS Clinical pregnancy (%) 46/96 (47.9) 52/94 (55.3) NS Multiple pregnancy (%) 15/46 (32.6) 17/52 (32.7) NS
32.
33.
34.
35. RESULTS OF SEARCH 9/23 10 RCTs (n= 2048) 7 RCTs : HA vs. P 1 RCT : HES vs. P 2 RCTs :HA vs. HES vs. P No RCTs compared dextran or haemaccel vs placebo
40. Conclusion OHSS is a preventable disease that should not be allowed to happen
41.
42. THANK YOU Dr. Hesham Al-Inany MD, PhD e-mail : hesham@khosoba.com
Editor's Notes
8 8 8
37 27 27
15 14 14
Pregnancy rate per transfer comparable with the long agonist protocol No severe OHSS in all studies This protocol should be considered as an option in patients with OHSS risk
Oocyte triggering with HCG have some drawbacks as:….. , while oocyte triggering with GnRH agonist means……
Oocyte triggering with HCG have some drawbacks as:….. , while oocyte triggering with GnRH agonist means……
Oocyte triggering with HCG have some drawbacks as:….. , while oocyte triggering with GnRH agonist means……
Oocyte triggering with HCG have some drawbacks as:….. , while oocyte triggering with GnRH agonist means……
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