Published on February 18, 2014
INDIVIDUALISED OVARIAN STIMULATION PROTOCOL (I COS)
Dr Shweta Kaul jha M.S.,FNB,FNAMS. Board Certified( National Board of Examination,New Delhi) Journey has just begun……..
LIVE BIRTH COST EFFECTIVE PATIENT FRIENDLY
CONVENTIONAL APPROACH LONG AGONIST PROTOCOL WITH STANDARD AGE DEFINED DOSES OF GONADOTROPHINS.
INDIVIDUALISED CONTROLLED OVARIAN PROTOCOLS (I COS)
Personalised care,Variability in ovarian response,Customised with aim at moderate oocyte numbers (10-15) and increased CPR and not no.of eggs .
HOW IS IT POSSIBLE NOW?
Newer Drugs and technologies Bye Bye Urinary gonadotrophins Recombinant Gonadotrophins filled by mass FBM. Embryo culture/Selection better. Vitrification vs slow freezing
HOW TO INDIVIDUALISE AND WHAT TO INDIVIDUALISE?
PREDICTION BASED ON ORT BUT Response is not equivalent to reserve Depending on Ovarian Reserve Tests we predicted Poor/normal and hyper responders
FUTURE Prediction of Ovarian response -Based on –Age Hormonal markers Functional markers Genetic markers BMI Ethinicity Cause of infertility
Best available marker-AMH for predicting number of oocyte but not to exclude from treatment. Less AMH does not mean less pregnancy.
FUNCTIONAL MARKER .
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
WHAT WENT WRONG?
SINGLE NUCLEOTIDE PROTEIN –In position 680 of FSH receptor is associated with altered response to stimulation. LH receptor mutation-may require LH supplementation.
PHARMACOGENETIC MODEL-MADE BY RECOGNISING GENETIC MARKERS.
CAUSE OF INFERTILITY
INDIVIDUALISE STARTING DOSE PROTOCOL ADJUVANTS TRIGGER
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
Multivariate predictive models. Valid in different poulations Simple to use in day to day practise Predictor models based on genetic markers
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