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The use of gonadotropins and biosimilars in ART treated cycles

Currently a variety of urinary and recombinant versions of gonadotropins are widely available and in use in IVF treatment. Numerous studies have tried to establish whether there is any clinical difference in terms of efficacy (mainly live birth rate) and/or safety (mainly risk of OHSS) between these modalities. Results have been inconclusive and somewhat conflicting. Views of practicing clinicians on this dilemma have not yet been assessed in large scale studies. In light of this controversy, the following survey is due to assess the opinion of practicing clinicians and their rationale behind their decision-making on this topic.

Survey results reflecting the collective wisdom of IVF experts will be published on IVF-Worldwide.

Do you think that there is a difference between urinary and recombinant gonadotropins in terms of efficacy (live birth rate)
  • No difference- they are the same
  • Urinary are more efficacious
  • Recombinants are more efficacious
  • I do not know

 

Do you think that there is a difference between urinary and recombinant gonadotropins in terms of safety- risk of OHSS
  • No difference- they are the same
  • Urinary are safer
  • Recombinants are safer
  • I do not know

 

Do you think there are long-term safety issues associated with the use of human urinary preparations?
  • No risk at all
  • There are potential unknown risks (such as prion disease)
  • I don’t know

 

How do you choose the starting dose of FSH?
  • Antral Follicle count
  • AMH measurement
  • Previous treatment cycle result
  • All of the above
  • Other criteria

 

In your country which drugs are cheaper for the patients or the health authorities
  • Urinary
  • Recombinant
  • They cost the same
  • I do not know the cost

 

What gonadotropins do you prescribe mostly to your patients?
  • Only urinary
  • Mostly urinary
  • Only recombinant
  • Mainly Recombinant
  • About the same proportion
  • I cannot estimate

 

In your unit who is the most important decision maker on which gonadotropins are used
  • Clinician
  • Hospital
  • Other

 

Which of the below is the MOST important in deciding which gonadotropin to prescribe?
  • Efficacy
  • Safety
  • Delivery system
  • Range of doses provided
  • Price
  • Patient preference

 

Are you aware of the new recombinant FSH biosimilars that are coming into the market?
  • Yes
  • No

 

Would you like to see more information on IVF-Worldwide about the new recombinant FSH biosimilars?
  • Yes
  • No

 

Do you have any experience to date of using the recombinant FSH biosimilars?
  • Yes
  • No

 

If you have used the new recombinant FSH biosimilars what is your view on their efficacy compared to previously used gonadotrophins in a similar patient group?
  • They are more efficacious
  • They are less efficacious
  • They are the same
  • I have no experience

 

Which GnRH analogue protocol do you use most frequently?
  • Short GnRH agonist
  • Long GnRH agonist
  • GnRH antagonist
  • Other

 

If you use the long GnRH agonist protocol what combination of drug(s) do you use?
  • A product with FSH and LH activity (LH/hCG)
  • FSH only
  • It does not matter

 

If you use the long GnRH agonist protocol do you start with:
  • Higher dose of gonadotropin in comparison with the GnRH antagonist protocol
  • Same dose of gonadotropin as with the antagonist protocol
  • Lower dose in comparison with the GnRH antagonist protocol
  • None of the above

 

Do you use the GnRH agonist to trigger final follicular maturation?
  • Yes in selected patients
  • In all of my patients
  • No, I use hCG
  • None of the above

 

Do you replace fresh embryos after triggering oocyte maturation with GnRH agonist
  • Yes, I replace embryos in this cycle
  • No, I freeze all embryos in this cycle
  • I make the decision individually

 

Replacing frozen-thawed embryos, in normal ovulatory women: which treatment do you prefer?
  • Prepare the endometrium with Estrogen/Progesterone
  • Natural cycle
  • Stimulated cycle
  • - Prepare the endometrium with Estrogen/Progesterone and Natural cycle (1 & 2)
  • All of the above
  • None

 

If you replace the frozen-thawed embryos in natural cycle do you:
  • Give hCG to schedule the time of replacement
  • Follow the spontaneous ovulation
  • Both
  • None of the above