Newsletter – October 5, 2010
The number of IVF units registered on the website has increased to 3155
IVF-Worldwide.com would like to congratulate and extend our great appreciation to Professor Robert G. Edwards for being awarded the 2010 Nobel Prize in Medicine.
Results of 179,300 IVF treatment cycles (262 centres from 68 countries )
The statistics was done based on the number of cycles each unit performed and not on the number of units.
The survey was compiled by Prof. Adam Balen, Leeds Centre for Reproductive Medicine, Seacroft Hospital, Leeds, U.K
This graph describes the number of cycles performed by each unit participating in the survey. The majority of the units performed up to 600 cycles per year (172 Units). There were only two units in this survey performing more than 4000 cycles per year.
Section 1: Definition and diagnosis of "PCOS" patients
Do you think that reaching a clear definition of the ovarian state is important for the treatment?
Do you define a patients with PCOS based on the Rotterdam ESHRE/ASRM Consensus Criteria? (Two of three criteria: Chronic anovulation; Clinical and/or biochemical evidence of hyperandrogenism, and Polycystic ovaries).
Do you measure LH/FSH ratio and androgens to define patients with PCOS?
In your opinion is androgen excess is a prerequisite for the definition of PCOS?
Do you routinely measure anti-Mullerian hormone (AMH)?
Should ultrasound appearance of PCO in the presence of anovulation, with normal prolactin be enough for the definition?
Should a definition of PCOS is important for the treatment?
Do you assess for Impaired Glucose Tolerance (IGT)?
If you assess for IGT is this in: (results presented are from the 73.3% who measured IGT
In the workup for diagnosis would you look for non-classical
Do you recommend treatment with Metformin (Glucophage) before starting the
Interesting to find is that even in such an extreme case, as presented here, the cancellation rate would be 19.3%. Although there is a meta-analysis advocating the use of albumin to prevent the development of OHSS, only 8.5% would use this treatment. Costing would become the major OHSS preventive method. Use of GnRH agonist to trigger final stage of ovulation was not mentioned here and several physicians would recommend the use of it.
It is interesting to find that for the majority of physicians, pre-treatment definition of the ovarian status is important. For PCOS the "Roterdam ESHRE/ASRM" criteria serve as the definition. This also includes measurement of LH/FSH ratio and androgens, although there is no clear cut which androgen should be measured. Anti Mullerian Hormone (AMH) also can serve for the definition.
In addition to the above, ultrasound in the presence of anovulation and normal prolactin was also described as satisfactory for the definition of patients with PCOS.
Clomiphene Citrate and Metformin still serve as the first line of treatment. For the use of gonadotropin the "Low Dose Step-up" protocols is the dominant one.
To prevent an ill-time LH surge during the IVF stimulation protocol, the preferable drug is GnRH antagonist. The preferable gondotropin for stimulation is the rec-FSH and the usual dose is around half of the regular dose in a none PCOS patient. The majority will not treat a patient with BMI above 35.
Comments received and printed (unedited version):
On behalf of the IVF-Worldwide team, Prof. Adam Balen and the, we would like to take this opportunity to thank all the centers that participated in the survey by adding to the global knowledge, as this could be of use around the world.
You may use the attached logo in your website in order to provide the link:
Prof. Zeev Shoham and Prof. Milton Leong