- May 7, 2010
The number of IVF units registered on the website has increased to 3118
The use of GnRH agonist in IVF protocols
The survey includes reports from 273 centres worldwide performing 151,000 IVF cycles annually.
|The survey was compiled by:
graph describes the number of cycles performed by each unit
participating in the survey. The majority of the units performed up to
400 cycles per year. There was only one unit, reporting to the survey,
performing more than 4000 cycles per year.
The use of GnRH agonist
The use of GnRH antagonist
The above difference is of around 1% showing that the results reported are consistent and probably very accurate.
can be estimate, on a global scale that around 10%-12% of all IVF
cycles are being performed with the use of GnRH antagonists.
Interesting to find is that the 37% used daily injection with decreasing the dose by half when they start stimulation. The use of nasal spay is still very popular. 10% still issue the depot GnRH agonist preparations.
reasons (37%) were the major cause of use of GnRH Depot preparation
among the 10% of the cycles in which Depot preparation was used. Second
indication (30%) was patient's convenient.
of those using GnRH depot preparation do not support their patients
with Estrogen if they do not conceived to prevent the unwanted symptoms
of chemical induce hypoestrogenic state.
|Using the long protocol is still the most popular one.
majority (51%) who used the short protocol start on day 2 of the cycle.
There is few other regimens using OC with the agonists.
on the mid-luteal phase is now the most common practice. The next
common one is starting long protocol during the last few days of the
More than 55% of the treated cycles the agonist dose was cut into half
in all patients and in additional 12% if the patients did not responded
well. So the majority of the physicians today decrease the dose of the
agonist when they start stimulation.
desensitization is being monitored in 92% of the survey cycles.
Ultrasound is the major tool in this procedure (88%) and serves alone
as a monitor in only 30% of the cycles. Ultrasound and serum levels of
Estradiol are used in the majority (61%) of cycles for monitoring.
thickness serves as part of the monitoring system and this is being
done with ultrasound. It seems that those who measure serum Estradiol
concentration would estimate this to be below 80-100 pg/ml (
|Most of the participants (52%) in the survey believe that the presence of non-functioning
does not influence the outcome and therefore start stimulation. 28%
will go forward with the cycle only after aspirating this cyst.|
in case of functioning cysts, the majority will continue treatment with
the agonists. Again 23% (almost similar to the above 28%) will aspirate
the cyst. Almost every one agrees that the presence of such a cyst can
influence the outcome and 13% will cancel the cycle.
is a common practice to start treatment with a dose in between 150 to
225 IU of FSH. 59% will start with 150 IU and 34% will start with 225
IU in the young normal responders group. Dosages bellow and above are
|Comparing the above results geographically between the USA and Europe showed major difference in treatment approach. In general the starting dose in the USA is higher for all groups of patients.
|The initial treatment dose of gonadotropin is much higher in the older age group, and it runs in between 225 to 300 IU/d.
|The starting dose of FSH in the USA in most of the cases is higher then the one in Europe.
56% there is no age limits for the use of long protocol of GnRH
agonists. However 44% will eliminate the use of this protocol in the
older age group.
|The majority agree that those who define as "poor responders" may benefit from another mode of treatment.
issue of adding routinely LH is coming back into question. 44% do not
add LH as a routine practice and 3% are stimulation with hMG only. 2%
are adding hCG as a routine practice. The rest would add either rec-LH
or hMG, at the beginning of the cycle or at a late stage of the
stimulation but this is only in small percentages. 28% stated that they
are flexible both with drugs and the protocols.
|When the issue of adding LH and the older age group was questioned still 47% do not routinely add and sort of LH.
the last few years several studies recommended the use of GnRH agonist
(short acting shot) in the mid-luteal phase. The above results do not
confirm that this was accepted in large in clinical practice.
Comments received to the survey:• Some questions can not be answered for non-agonist users. This practice uses GnRH-agonist as an hCG substitute trigger, however this survey was not intended for this critical information.
• Main use of GnRH agonist is to safely trigger high responders.
• It is worthwhile knowing the preparation one uses as they differ in potency.
• Ultrashort protocol (4 days of GnRH agonist) is a good choice in the first attempt in all groups of patients (low and good responders)
• I do not add routinely LH in the GnRH agonist, but I check the LH level after 6 days of stimulation and I add recombinant LH if the LH is below 1.5 mIU/mL
|On behalf of the IVF-Worldwide team Prof. Fauser, Dr. Tur-Kaspa and the Advisory Board of the website, we would like to take this opportunity to thank all the centers that participated in the survey by adding to the global knowledge, as this could be of use around the world.|
A New Service – The CRYO Forum
Amir Arav and Prof. Gabor Vajta, world leaders in the filed of
cryopreservation, have posted on the IVF-Worldwide website two topics
for your comments and discussion.
Please enter this section and add your comments.
Do we need high speed vitrification? Posted by Prof. Amir Arav
Prof. Amir Arav
Co-chairman of the CRYO congress in Valencia , 27-30,2010,
Recently, Mazur has shown the dominance of warming rate on cooling rate during vitrification, the survival of mouse oocytes after very slow cooling rate (<200°C/min) with high warming rate (>2000?C/min) was very high in compared to those cooled very rapidly and warmed slowly. However, we and others have shown that this is not the case for chilling sensitive oocytes and embryos such as bovine, pig, rabbit and human (Arav et al., 1997, Isachenko et al., 2001, Cuello et al., 2004, Beebe et al., 2005, Santos et al., 2006, Lee et al., 2007, Papis et al., 2009). Do we need high speed vitrification?
Add you comments at the Cryo Forum at: http://www.ivf-worldwide.com/
What is the legal situation of open vitrification systems in different countries? Posted by Gabor Vajta
Moderator: Prof. Gabor Vajta
Co-chairman of the CRYO congress in Valencia May 27-20, 27-30,2010,