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