文献_Individualized versus standard stimulation.pdfVIP

Individualized versus standard stimulation Pr François OLIVENNES, MD, PhD ART unit Eylau La Muette Paris, France Predictors of ovarian response Ovarian response: — Condition the incidence of cancellation — Play an important role in pregnancy rates The use of ovarian response predictors could help us to individualize treatment protocols Predictors can — Avoid poor response and OHSS, — Avoid cancellation — Individualize treatment — Choose the starting dose of gonadotrophins Predictors for ovarian response in ART fall into 3 main categories 1. Clinical: Age, Cause of infertility,BMI (eg Templeton Morris, 1998; Hohmann et al 2001, Salha et al 2001) 2. Ultrasound: Number of antral follicles, Doppler score (resistance), Ovarian volume (eg Lass et al 1997; Fratterelli et al 2000; Popovic Todorovic et al 2003; Hansen et al 2003; Scheffer et al 1999: 2003; Van Rooij 2002; Bancsi 2003, 2004, Hendriks 2005) 3. Hormone levels Basal FSH,Inhibin B, oestradiol, AMH (eg Toner et al 1991; Scott 1989,1996; Fratterelli et al 2000 Abdallah Thum 2004; Eldar-Geva 2002; Fanchin 2003; Bancsi 2002, 2003, Visser 2005, Hendriks 2005) Scientific papers analysed in the review FSH Scott et al.,1989; Padilla et al., 1990; Toner et al., 1991; Khalifa et al., 1992;Chan et al., 1993; Ebrahim et al., 1993; Fanchin et al., 1994;Huyser et al., 1995; Licciardi et al., 1995; Smotrich et al., 1995;Balasch et al., 1996; Csemiczky et al., 1996; Martin et al., 1996;Pruksananonda et al., 1996; Gurgan et al., 1997; Chang et al.,1998a; Evers et al., 1998; Ranieri et al., 1998; Sharif et al., 1998;B