The use of GnRH agonist in IVF protocols

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The use of GnRH agonist in IVF protocols

The survey was compiled by Dr. Ilan Tur-Kaspa, President and Medical Director, Institute for Human Reproduction (IHR), Chicago, USA, and Prof. Bart Fauser, Head, Department of Obstetrics and Gynecology, University of Utrecht Medical Center, Utrecht, The Netherlands

Generic names: Buserelin, Goserelin, Luprorelin, Luprolide, Naferelin, Triptorelin
Histrelin, Deslorelin,

Trade names: Superecure, Superefact, Zoladex, Lupron depot, Prostap SR, Enantone, Lucrin depot, Trenantone-Gyn, Synarella, Synarel, Decapeptyl SR, Gonapeptyl

Since the first publication of Porter et al. Induction of ovulation for in-vitro fertilization using buserelin and gonadotropins, Lancet 1984;2:1284, there were several protocols that have been developed. This survey relates to current practice, opinions and therapeutic approaches to patient preparation for IVF using GnRH agonist.

The personal data requested aims only to assure the safety and authenticity of the data submitted. No personal data will be published.

Name

Name of IVF Center (Unit)

E-mail

1. Country

2. Estimated number of total IVF cycles performed by the unit annually

3. Can you estimate the percentage of your patients receiving GnRH agonist per year?

4. Can you estimate the percentage of your patients receiving GnRH antagonist per year?

5. What are the reasons for giving a GnRH antagonist co-treatment in some patients?

6. When using a GnRH agonist, what type of preparation do you generally use?

1- Depot GnRH agonists (one injection per treatment cycle)
2- Daily injection – constant dose
3- Daily injection – decrease to 1/2 dose when starting gonadotropins
4- Nasal Spray
5- Both
6- None of the above

7. Can you estimate the percentage of your patients that received Depot GnRH preparations?

8. Why use a Depot preparation?

9. If you use Depot GnRH agonists and the patients did not conceive, do you supplement the patients with estrogen to prevent a hypoestrogenic state?

1- I do not use it
2- No, I do not think there is a need for such treatment
3- Yes, I support those who do not conceive with estrogen for a month
4- Yes, I support them only if they present with symptoms

10. What is the most common protocol that you use for GnRH agonist treatment?

1- Long protocol
2- Short protocol
3- Micro-dose flare protocol
4- None of the above

11. If you use the long protocol, when do you start?

1- Long protocol starting around day 21 of the cycle
2- Long protocol starting around day 2 of the cycle
3- Oral Contraception with Long protocol starting during the last few days of the pills
4- None of the above

12. If you use the short protocol, how do you treat?

1- Flare-up (short protocol) protocol starting on day 2 of the cycle
2- Oral Contraception with Flare-up (short protocol) protocol
3- Oral Contraception with Micro-dose GnRH agonist protocol
4- None of the above

13. Can you estimate the percentage of your patients that received Daily (short acting) GnRH preparations for the Short Protocol (Flare-up Protocol)

14. If you use a daily preparation, do you cut the dose of the agonists by half when you start stimulation?

1- Yes
2- No
3- Only if the patients did not respond well in a previous cycle
4- Depends on the age of the patients, and only in the older group

15. Do you monitor pituitary desensitization with?

1- No need for monitoring
2- U/S only (endometrium and ovary)
3- Estradiol and ultrasound
4- Estradiol, LH and FSH
5- Estradiol, LH and FSH, and ultrasound
6- Estradiol, progesterone and ultrasound
7- Estradiol, progesterone, FSH, LH and ultrasound

16. In the case of a functioning ovarian cyst with elevated Estradiol levels, you would recommend:

1- Since it would not change the outcome – to start stimulation
2- Continue GnRH agonist and repeat testing in one week
3- Cancel the cycle
4- Aspirate the cyst and continue treatment

17. In the case of a nonfunctioning ovarian cyst with normal Estradiol levels, you would recommend:

1- Since it would not change the outcome – to start stimulation
2- Continue GnRH agonist and repeat testing in one week
3- Cancel the cycle
4- Aspirate the cyst and continue treatment

18. What is the starting dose of Gonadotropin with a long GnRH agonist protocol for normal responders less than 35 years of age, used in your clinic?

19. What is the starting dose of Gonadotropin with a long GnRH agonist protocol for normal responders 35-39 years of age, used in your clinic?

20. When endomterial thickness is less than 5 mm, do you have a cutoff for estradiol level to start stimulation?

1- Less than 60 pg/ml (228 pmol/l)
2- Less than 80 pg/ml (304 pmol/l)
3- Less than100 pg/ml (380 pmol/l)
4- Less than120 pg/ml (456 pmol/l)
5- Less than150 pg/ml (570 pmol/l)
6- None of the above

21. Do you have age limits for using long down regulation protocols with GnRH agonists?

22. Do you use long down regulation protocols with GnRH agonists for poor responders?

1- Yes
2- No

23. With a long GnRH agonist protocol, do you routinely add recombinant-LH/hMG or hCG?

1- No
2- Yes, being flexible with the drugs
3- Yes, I use the FSH/hMG protocol for the first few days of stimulation
4- Yes, I use the FSH/hMG protocol for the last few days of stimulation
5- Yes, I add only Recombinant LH to FSH for the first few days of stimulation
6- Yes, I add only Recombinant LH to FSH for the Last few days of stimulation
7- Yes, I add a low-dose of hCG to FSH
8- Yes, I use only hMG for stimulation (no FSH)

24. Do you add LH, or treat with hMG routinely in the older group of patients under the agonist protocol?

25. Do you add 6 days after OPU, for luteal support, one injection of daily dose of GnRH agonist?

1- No
2- Yes, if agonist protocol was used
3- Yes, if antagonist protocol was used
4- Yes, no matter which protocol was used during stimulation

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