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Kötü yanItlI hastalarda antagonİst uygulamalarI

Kötü yanItlI hastalarda antagonİst uygulamalarI. PROF.DR.SEDAT KADANALI. GnRH AGONİST. GnRH ANTAGONİST. POOR RESPONDER. 2005. BACKGROUND . This is the first published report of a prospective, randomized, controlled trial comparing a

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Kötü yanItlI hastalarda antagonİst uygulamalarI

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  1. Kötü yanItlI hastalarda antagonİstuygulamalarI PROF.DR.SEDAT KADANALI

  2. GnRH AGONİST GnRH ANTAGONİST POOR RESPONDER

  3. 2005 BACKGROUND. This is the first published report of a prospective, randomized, controlled trial comparing a fixed, multi-dose GnRH antagonist protocol with a long GnRH agonist protocol in poor responders undergoing IVF.

  4. the first published report

  5. Human Reproduction Update, Vol.12, No.6 pp. 651–671, 2006 doi:10.1093/humupd/dml038 Advance Access publication August 18, 2006 Among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth dependent on the type of analogue used? A systematic reviewand meta-analysis E.M.Kolibianakis1,5, J.Collins2, B.C.Tarlatzis1, P.Devroey3, K.Diedrich4 and G.Griesinger4 Canlı Doğum Oranı

  6. Meta-analysis of the number of oocytes retrieved with different pituitary suppression regimens in poor responders. Sunkaraet al.Reproductive Health2007 4:12   doi:10.1186/1742-4755-4-12

  7. STİMULASYON SÜRESİ

  8. OOSİT SAYISI

  9. SİKLUS İPTALİ

  10. KLİNİK GEBELİK ORANI

  11. GnRH-analog uygulamaları -long protokol -short -ultrashort -minidoz -stop Lupron -mikrodoz+ GH GnRH-antagonist uygulamaları -Fixed -Fleksible -Letrozol ile -GnRH-a flare ile -Luteal (CRASH) -E2 priming HANGİSİ İLE KARŞILAŞTIRILACAK?

  12. İleri yaş(>40 yaş)veya POR risk faktörü varlığı En az ikisi olmalı -Daha önce POR hikayesi (Konvansiyonel protokolde oosit< 3 oosit) -Anormal over rezerv testleri (AFC < 5-7, AMH < 0.1-1.1)

  13. FLEKSİBLE ANTAGONİST SHORT AGONİSTTEN DAHA İYİ

  14. the GnRH-a long regimen, (2) the GnRH-a short regimen (3) the GnRH antagonistreg.

  15. GnRh-antagonist GnRh-a long Klinik gebelik açısından

  16. GnRh-antagonist GnRh-a flare-up Klinik gebelik açısından

  17. Flex.GnR-antagonist GnRh-a minidoz Klinik gebelik açısından

  18. GnRh-a flare-upGnRh-a modifiyelong Klinik gebelik açısından

  19. A U T H O R S ’ C O N C L U S I O N S Implicationsforpractice There is insufficient evidence to identify the use of any one particularintervention to improve treatment outcomes in poor responders in IVF. The results of this review should be balanced by acareful consideration of the small number of trials, small numberof participants and the heterogeneity between the trials. Given the cost of the treatments and the lack of goodevidence, it would seemreasonable to say that these

  20. GnRH-a ile GnRH-ant. karşılaştırmak için kaç vaka gerekiyor? Klinik gebelik oranındaki % 5 lik farkı ortaya koymak için % 25 lik beklenen bir gebelik oranında,β-hata 0.2 ve α-hata 0.05 kabul edilldiğinde Her iki grup için 1252 olmak üzere toplam 2504 hasta gerekir

  21. Antagonist poorresponder AKLIMIZDA NE KALDI ?

  22. POOR RESPONDER • IS • POOR RESPONDER Antagonistler kötü over yanıtlı hastalarda bir alternatiftir Kötü over yanıtlı hastalarda GnRH antagonist/ agonist karşılaştırmaları net bir mesaj verememektedir. Randomizasyonu ve metodolojisi iyi planlanmuş çalışmalara ihtiyaç vardır

  23. BAŞARILI VE VERİMLİ BİR KONGRE GEÇİRMENİZ DİLEKLERİMLE…

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