AGO AGO

RESULTS

SUMMERY

Continued daily GnRHa administration is an efficient luteal support method in GnRHa triggered high response patients.

By this method fresh-embryo transfer can be achieved with minimal risk for OHSS and excellent pregnancy rate.

These results should be confirmed by larger series of patients

The earliest day of cessation the analog support without harming the pregnancy rate should be determined.

Hiking

Karst landform

DISCUSSION

Human Activities

Canoeing

• Famous for its karst landform
• formed when underground water is dissolved in the gypsum bedrock
• a dangerous place to live near

Ecozones

DISCUSSION

GnRH safety:

• Animal studies did not indicate any teratogenic effects Marcus 2001
• Until 1998, more than 340 unexpected spontaneous pregnancies have been inadvertently exposed to GnRHa administration. Among these, a congenital abnormality incidence of 2.5% and a pregnancy loss of 15% was seen Cachill 1998
• For many years GnRH depots, such as 3.75 mg Decapeptyl, were routinely incorporated in many long protocol ART treatments Orvieto 2002

Advantages:

Avoiding OHSS in high-responders, while enabling fresh embryo transfer

“Patient-friendly”

Excellent pregnancy rate

Limitations:

GnRHa for final ooctye maturation is not 100% efficient.

OHSS is not 100% prevented by GnRHa triggering

Small sample size

No control group

Possible mechanisms for GnRHa effect:

Stimulates secretion of LH for CL maintenance

LH also has beneficial effect on the endometrium (GnRH receptors are expressed in both the stroma and epithelial cells of the endometrium)

Tesarik J, Luteinizing hormone affects uterine receptivity independently of ovarian function. Reprod Biomed Online 2003

May have direct effect on the embryo

Tesarik J, Beneficial effect of luteal-phase GnRH agonist administration on embryo implantation after ICSI in both GnRH agonist- and antagonist-treated ovarian stimulation cycles. Hum Reprod 2006

• Want to go in the wilderness? Look no further
• Experience the magnificent Boreal wilderness
• Lets you take a short relaxing stroll or super energetic hikes

• During the day
• Fishing and wild life viewing
• At night
• Sit back beside a campfire, tell stories while looking at the Northern Lights

An example of a karst landform

• Sits on one ecozone: Boreal
• consists mostly pines, spruces and larches
• heavy precipitation all year long
• mild summers
• very cold winters

• Like to canoe? Visit Wood Buffalo!
• Pine lake provides easy day paddling and even a route that suites your style!
• Never canoed before? There are rentals!
• Wood Buffalo is definitely a place to start.

DISCUSSION

Possible mechanisms for GnRHa effect:

Stimulates secretion of LH for CL maintenance

LH also has beneficial effect on the endometrium (GnRH receptors are expressed in both the stroma and epithelial cells of the endometrium)

Tesarik J, Luteinizing hormone affects uterine receptivity independently of ovarian function. Reprod Biomed Online 2003

May have direct effect on the embryo

Tesarik J, Beneficial effect of luteal-phase GnRH agonist administration on embryo implantation after ICSI in both GnRH agonist- and antagonist-treated ovarian stimulation cycles. Hum Reprod 2006

DISCUSSION

This study is a proof of concept that demonstrates that repeated GnRHa for luteal-phase support is an efficient luteal support method in hyper-responsive patients triggered with GnRh analog for final oocyte maturation, enabling fresh-embryo transfer with a minimal risk for OHSS and with the achievement of high pregnancy rate

RESULTS

24 ongoing pregnancies (52.1%).

One patient had a miscarriage

Nafarelin treatment was well tolerated by all patients. No significant adverse events were reported

None of the patients developed clinical signs of early or late OHSS

RESULTS

• Retrospective cohort
• 46 IVF patients
• High risk for OHSS (pco thin type previous ohss, high response)
• Private clinic
• May 2014 – December 2015
• Antagonist protocol
• None of the patients underwent coasting
• Ovulation induction: 0.2 mg Decapeptyl
• Luteal support initiated on the evening after OPU with nafarelin inhaler: 200 mcg *2/d (Synarel, Pfizer).
• No other supplementation for luteal support was given
• Fresh embryo transfer was carried out in all patients
• E2 and P levels were evaluated in mid-luteal phase to confirm satisfactory luteal support.
• GnRHa administration was terminated 2 weeks after OPU
• In cases with positive serum hCG results, no additional luteal support was provided

The analog-analog combination, a novel approach to avoid OHSS and enable fresh embryo transfer in high responders

Itai Bar-Hava, MD

Fertility center from A to Kids

Tel-Aviv, Israel

nice pic bfore a boring graph

Climate Graph: Fort McMurray