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Management of Poor Or Hyper Ovarian response
Ovarian Reserve ,[object Object],[object Object]
No. of Primordial Follicles Erickson GF 2000, Adashi EY (ed) N. Y. 31-48 Gougheon A, (2004) in Leung PK et al., (ed) San Diego 25-43. No. of oocytes 7 th  Month of gestation 7.000.000 At Birth 2.000.000 Age of seven year 300.000 Puberty 40.000 Released by ovulation 400 – 500
Prediction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pregnancy rate
[object Object]
AMH ,[object Object],[object Object],[object Object],[object Object]
During Induction? ,[object Object],[object Object],[object Object]
Poor Response ,[object Object],[object Object],[object Object],[object Object]
PREGNANCY RATE ACCORDING TO AGE AND NUMBER OF OOCYTES RETRIEVED
What is poor response in IVF ,[object Object],[object Object],[object Object]
LOW RESPONDERS CLASSIFICATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What to do  ,[object Object]
Cancellation ,[object Object],[object Object],[object Object]
In subsequent cycles ,[object Object]
[object Object],[object Object]
Protocols for IVF  GnRH Antagonist Protocols GnRH  Agonist Protocols   225 IU per day (150 IU Europe) Individualized Dosing of FSH/HMG 250   g per day antagonist Individualized Dosing of FSH/HMG GnRHa 1.0 mg per day  up to 21 days 0.5 mg per day of GnRHa 225 IU per day (150 IU Europe) Day 6 of  FSH/HMG Day of  hCG Day 1  of FSH/HMG Day 6 of  FSH/HMG Day of hCG 7 – 8 days after estimated ovulation Down regulation Day 2 or 3 of menses Day 1  FSH/HMG OCP
Protocols for poor responders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Short (flare up protocol): ,[object Object],[object Object]
Ultra-short protocol ,[object Object],[object Object],[object Object]
[object Object]
Growth hormone ,[object Object],[object Object]
NC ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object]
Poor response TI/IUI Gonadotrophins Modified natural cycle ” Antagonist “ IVM” IVF
Hyperresponse 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
[object Object],[object Object],[object Object],[object Object],[object Object]
Coasting is a routine practice at  The   Egyptian IVF-ET Center (May 2001 – May 2003) No. of Cycles  4969 No. of Coasting  560 Mean E 2  on hCG day   3742  +  1074 Days of Coasting 2 – 6 No. of Oocytes 18  +  7 No. of Cancelled ET (cryopreservation of all embryos) 3 OHSS (%) 6 (1.2 per 1000) Clinical Pregnancy (%) 265 (47.32%)
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GnRH antagonist In a Cochrane review by Al-Inany , Abousetta and Aboulghar (2005) comparing agonist and antagonist, significant difference in the incidence of OHSS was found.
Novel Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THANK YOU

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Management of poor ovarian response

  • 1. Management of Poor Or Hyper Ovarian response
  • 2.
  • 3. No. of Primordial Follicles Erickson GF 2000, Adashi EY (ed) N. Y. 31-48 Gougheon A, (2004) in Leung PK et al., (ed) San Diego 25-43. No. of oocytes 7 th Month of gestation 7.000.000 At Birth 2.000.000 Age of seven year 300.000 Puberty 40.000 Released by ovulation 400 – 500
  • 4.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10. PREGNANCY RATE ACCORDING TO AGE AND NUMBER OF OOCYTES RETRIEVED
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. Protocols for IVF GnRH Antagonist Protocols GnRH Agonist Protocols 225 IU per day (150 IU Europe) Individualized Dosing of FSH/HMG 250  g per day antagonist Individualized Dosing of FSH/HMG GnRHa 1.0 mg per day up to 21 days 0.5 mg per day of GnRHa 225 IU per day (150 IU Europe) Day 6 of FSH/HMG Day of hCG Day 1 of FSH/HMG Day 6 of FSH/HMG Day of hCG 7 – 8 days after estimated ovulation Down regulation Day 2 or 3 of menses Day 1 FSH/HMG OCP
  • 18.
  • 19.
  • 20.
  • 21.
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  • 23.
  • 24.
  • 25.
  • 26.
  • 27. Poor response TI/IUI Gonadotrophins Modified natural cycle ” Antagonist “ IVM” IVF
  • 28. Hyperresponse 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
  • 29.
  • 30. Coasting is a routine practice at The Egyptian IVF-ET Center (May 2001 – May 2003) No. of Cycles 4969 No. of Coasting 560 Mean E 2 on hCG day 3742 + 1074 Days of Coasting 2 – 6 No. of Oocytes 18 + 7 No. of Cancelled ET (cryopreservation of all embryos) 3 OHSS (%) 6 (1.2 per 1000) Clinical Pregnancy (%) 265 (47.32%)
  • 31.
  • 32. GnRH antagonist In a Cochrane review by Al-Inany , Abousetta and Aboulghar (2005) comparing agonist and antagonist, significant difference in the incidence of OHSS was found.
  • 33.