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The use of GnRH agonist in IVF protocols

 

Can you estimate the percentage of your patients receiving GnRH agonist per year?
  • None
  • All
  • Less than 10%
  • 10%-20%
  • 20%-30%
  • 30%-40%
  • 40%-50%
  • 50%-60%
  • 60%-70%
  • 70%-80%
  • 80%-90%
  • >90%

 

Can you estimate the percentage of your patients receiving GnRH antagonist per year?
  • None
  • All
  • Less than 10%
  • 10%-20%
  • 20%-30%
  • 30%-40%
  • 40%-50%
  • 50%-60%
  • 60%-70%
  • 70%-80%
  • 80%-90%
  • >90%

 

What are the reasons for giving a GnRH antagonist co-treatment in some patients?
  • A: Low responders; poor responders
  • B: Older age
  • C: High responders (PCO)
  • A and B
  • A and B and C
  • Other
  • do not use a GnRH antagonist

 

When using a GnRH agonist, what type of preparation do you generally use?
  • Depot GnRH agonists (one injection per treatment cycle)
  • Daily injection – constant dose
  • Daily injection – decrease to 1/2 dose when starting gonadotropins
  • Nasal Spray
  • Both
  • None of the above

 

Can you estimate the percentage of your patients that received Depot GnRH preparations?
  • None
  • All
  • Less than 10%
  • 10%-20%
  • 20%-30%
  • 30%-40%
  • 40%-50%
  • 50%-60%
  • 60%-70%
  • 70%-80%
  • 80%-90%
  • >90%

 

Why use a Depot preparation?
  • I do not use it
  • Medical reasons
  • Convenient for patients
  • Convenient for the center
  • Availability
  • Costs
  • All of the above
  • None of the above

 

If you use Depot GnRH agonists and the patients did not conceive, do you supplement the patients with estrogen to prevent a hypoestrogenic state?
  • I do not use it
  • No, I do not think there is a need for such treatment
  • Yes, I support those who do not conceive with estrogen for a month
  • Yes, I support them only if they present with symptoms

 

What is the most common protocol that you use for GnRH agonist treatment?
  • Long protocol
  • Short protocol
  • Micro-dose flare protocol
  • None of the above

 

If you use the long protocol, when do you start?
  • Long protocol starting around day 21 of the cycle
  • Long protocol starting around day 2 of the cycle
  • Oral Contraception with Long protocol starting during the last few days of the pills
  • None of the above

 

If you use the short protocol, how do you treat?
  • Flare-up (short protocol) protocol starting on day 2 of the cycle
  • Oral Contraception with Flare-up (short protocol) protocol
  • Oral Contraception with Micro-dose GnRH agonist protocol
  • None of the above

 

Can you estimate the percentage of your patients that received Daily (short acting) GnRH preparations for the Short Protocol (Flare-up Protocol)
  • None
  • All
  • Less than 10%
  • 10%-20%
  • 20%-30%
  • 30%-40%
  • 40%-50%
  • 50%-60%
  • 60%-70%
  • 70%-80%
  • 80%-90%
  • >90%

 

If you use a daily preparation, do you cut the dose of the agonists by half when you start stimulation?
  • Yes
  • No
  • Only if the patients did not respond well in a previous cycle
  • Depends on the age of the patients, and only in the older group

 

Do you monitor pituitary desensitization with?
  • No need for monitoring
  • U/S only (endometrium and ovary)
  • Estradiol and ultrasound
  • Estradiol, LH and FSH
  • Estradiol, LH and FSH, and ultrasound
  • Estradiol, progesterone and ultrasound
  • Estradiol, progesterone, FSH, LH and ultrasound

 

In the case of a functioning ovarian cyst with elevated Estradiol levels, you would recommend:
  • Since it would not change the outcome – to start stimulation
  • Continue GnRH agonist and repeat testing in one week
  • Cancel the cycle
  • Aspirate the cyst and continue treatment

 

In the case of a nonfunctioning ovarian cyst with normal Estradiol levels, you would recommend:
  • Since it would not change the outcome – to start stimulation
  • Continue GnRH agonist and repeat testing in one week
  • Cancel the cycle
  • Aspirate the cyst and continue treatment

 

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?
  • 100 IU/day
  • 150 IU/day
  • 225 IU/day
  • 300 IU/day
  • Other

 

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?
  • 100 IU/day
  • 150 IU/day
  • 225 IU/day
  • 300 IU/day
  • Other

 

When endomterial thickness is less than 5 mm, do you have a cutoff for estradiol level to start stimulation?
  • Less than 60 pg/ml (228 pmol/l)
  • Less than 80 pg/ml (304 pmol/l)
  • Less than100 pg/ml (380 pmol/l)
  • Less than120 pg/ml (456 pmol/l)
  • Less than150 pg/ml (570 pmol/l)
  • None of the above

 

Do you have age limits for using long down regulation protocols with GnRH agonists?
  • No
  • Women age less than 35
  • Women age less than 38
  • Women age less than 40
  • Women age less than 42

 

Do you use long down regulation protocols with GnRH agonists for poor responders?
  • Yes
  • No

 

With a long GnRH agonist protocol, do you routinely add recombinant-LH/hMG or hCG?
  • No
  • Yes, being flexible with the drugs
  • Yes, I use the FSH/hMG protocol for the first few days of stimulation
  • Yes, I use the FSH/hMG protocol for the last few days of stimulation
  • Yes, I add only Recombinant LH to FSH for the first few days of stimulation
  • Yes, I add only Recombinant LH to FSH for the Last few days of stimulation
  • Yes, I add a low-dose of hCG to FSH
  • Yes, I use only hMG for stimulation (no FSH)

 

Do you add LH, or treat with hMG routinely in the older group of patients under the agonist protocol?
  • No
  • >35 year-old
  • >38 year-old
  • >40 year-old
  • >42 year-old

 

Do you add 6 days after OPU, for luteal support, one injection of daily dose of GnRH agonist?
  • No
  • Yes, if agonist protocol was used
  • Yes, if antagonist protocol was used
  • Yes, no matter which protocol was used during stimulation