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PROTOCOLS OVULATION INDUCTION (sharing personal experience) DR . SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR

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Anovulation maybe the cause for infertility in 25% of couples presenting to infertility clinics.

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PROTOCOLS OVULATION INDUCTION (sharing personal experience) DR . SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR

  1. 1. PROTOCOLS OVULATION INDUCTION (sharing personal experience) …..Caring hearts, healing hands DR . SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
  2. 2. Anovulation maybe the cause for infertility in 25% of couples presenting to infertility clinics.
  3. 3. Group 1: Hypothalamic pituitary failure/ Hypogonadotrophic hypogonadism Group 2:Hypothalamic pituitary dysfunction / Normogonadotrophic anovulation Group 3: Hypergonadotropick hypogonadism/ premature ovarian failure Ovulatory dysfunction is known to be of three kinds based on the WHO classification (1976).
  4. 4. OVULATION Ovulation may need to be : . Induced in Ovulatory disorders . Most of the times needed for ART cycles e.g. IUI , IVF
  5. 5. AIM 1. Aim of induction should be Monofolliculogenesis When OI is carried out for simple procedures like TIMED IC or IUI. 2. In other ART cycles MULTIFOLLICULOGENESIS is the need. This is also called Controlled ovarian hyperstimulation or COH .
  6. 6. PROTOCOLS Choice of Ovulation induction protocol is INDIVIDUALIZED and would depend upon the type of patient and the procedure to be adopted .
  7. 7. AGENT FOR OI ORAL AGENTS *Clomiphene Citrate *Tamoxifene *Aromatase inhibitors (banned in India)
  8. 8. Gonadotrophins *Urinary *HP Urinary *Recombinant GnRh analogues: * Agonists * Antagonists INJECTABLES
  9. 9. CLOMIPHENE CITRATE : Dose 50-100mg ./day starting from the 2nd ,3rd or 5th day of menstrual cycle for five days. The dose can be stepped up to 150mg maximum. It has been noticed that the maximal benefit is achieved at lower doses & in 1st 3 cycles.
  10. 10. TAMOXIFENE : Can be used in clomiphene failure Dose: 20 mg twice daily starting from daily starting from day 2 - 5
  11. 11. USG Monitoring / HCG TRIGGER • U/S monitoring can be started from day 10-11 of the cycle . • HCG 5000 IU trigger is generally required at higher doses of CC.
  12. 12. WHO GROUP 1 HMG 150 IU daily is the drug of choice . • Long stimulation is required • Follicle may appear on U/S only after 14-15day of stimulation .one has to be patient for good results
  13. 13. Risk of ovarian hyperstimulation is very high in this group hence stimulation has to be slow and cautious. FSH or HMG maybe used at minimal doses -75 IU/ Day and stepped if no follicle is seen after 7 days of stimulation (step up regime). • Alternately ,higher dose of 150 iu maybe given in the beginning and stepped down after a follicle is seen on U/S.(step down regime). WHO GROUP 2
  14. 14. GnRH Agonists and Antagonists Generally used in ART protocols where multifolliculogensis is desired ************ Agonist can be used as a trigger when OHSS is feared and needs to be avoided.
  15. 15. GnRH Antagonists Antagonists can be used in ART cycles or IUI cycle with CC also ---- in a dose of 0.25 ugms / Daily when the follicle size is 14 mm in order to avoid pre-mature LH surge , to prevent premature rupture
  16. 16. OC Pretreatment – Long Protocol Day 5 Day 21 Day 3 Day 14 HCG GnRha Advantages • No Cyst Formation • No premature LH surge • No cycle cancellation • Cycle programming possible • Improved responses to Gonadotrophin
  17. 17. Day 1 Day 14 FSH / HMG day 3 hCG • Advantages of flare effect – idea for poor responders & prevents LH surge. PROTOCOL – SHORT
  18. 18. Day 1 Day 14 GnRha hCG Day 3 FSH / HMG • Advantage of flare effect – ideal for poor responders • Disadvantage of premature LH surge. Protocol – Ultrashort
  19. 19. Agonist 1st inj. Agonist 2nd inj. Agonist 3rd inj. Day 1 or 21 4 weeks 4 weeks rFSH Ovarian stimulation in severe endometriosis (long long protocol)
  20. 20. IMPORTANT TIPS • To get the best results in ART cycles , OI is must even for subtle ovulatory disorders • All cycles need to be monitored to prevent complications and to get the best results • Ovulation induction protocol needs to be INDIVIDUALIZED • Once ovulation is documented , same protocol and dose should be used in susequent cycles
  21. 21. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 CONTACT US 9650588339 9599044257 011-22414049 WEBSITE : www.lifecareivf.in www.lifecarecentre.in www.lifecareabs.in ISO 14001:2004 (EMS) …..Caring hearts, healing hands ISO 9001:2008 Helpline : 9599044257 Web.www.lifecareivf.in Helpline : 9910081484 26 Year In your service

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