survey

Blood hormone monitoring in controlled ovarian stimulation

 

Background

Due to changes in monitoring patients that may be attributed to the coronavirus pandemic, we would like to get input on your current practice of blood hormone monitoring during ART treatment. We would appreciate if you could spare a minute or two to answer a few short survey questions on the topic. It is important to emphasize that the survey covers only current practice, such as what blood hormone monitoring you perform, as well as when and how often – during treatment using controlled ovarian stimulation for ART.

 

Survey results and analysis

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Blood hormone monitoring in controlled ovarian stimulation

Due to changes in monitoring patients that may be attributed to the coronavirus pandemic, we would like to get input on your current practice of blood hormone monitoring during ART treatment. We would appreciate if you could spare a minute or two to answer a few short survey questions on the topic.

It is important to emphasize that the survey covers only current practice, such as what blood hormone monitoring you perform, as well as when and how often – during treatment using controlled ovarian stimulation for ART.

Please specify your medical specialty:
  • Clinician
  • Embryologist
  • Nurse
  • Other

 

How many years have you practiced reproductive medicine? (Please check the answer that applies)
  • Less than 3 years
  • 3 to 5 years
  • 6 -10 years
  • 11 -15 years
  • 16-20 years
  • 21-25 years
  • 26-30 years
  • More than 30 years

 

Is your reproductive medicine center a private or public practice?
  • Public
  • Private
  • Both
  • Other

 

Is ART treatment reimbursed in your country?
  • Fully reimbursed
  • Partially reimbursed
  • Not reimbursed

 

How many oocyte aspiration cycles are performed in your clinic annually?
  • Less than 100
  • 101-500
  • 501-100
  • 1001-1500
  • 1501-2000
  • 2001-3000
  • 3001-4000
  • More than 4000

 

What is the percentage of fresh embryo transfer cycles out of all embryo transfer cycles in your center?
  • 25% or less
  • 26%-50%
  • 51%-75%
  • 76%-99%
  • 100%

 

What is the percentage of freeze-all embryo cycles out of all oocyte aspiration cycles in your center?
  • 25% or less
  • 26%-50%
  • 51%-75%
  • 76%-99%
  • 100%

 

Which tests do you perform during the first clinic visit after the first gonadotropin injection? (Check all that apply)
  • Ultrasound
  • E2
  • P4
  • LH
  • FSH
  • Other

 

Which tests do you perform during the 2nd/3rd clinic visit during controlled ovarian stimulation? (Check all that apply)
  • Ultrasound
  • E2
  • P4
  • LH
  • FSH
  • Other

 

Which tests do you perform on or before the day of ovulation triggering? (Check all that apply)
  • Ultrasound
  • E2
  • P4
  • LH
  • FSH
  • Other

 

How do you adjust the gonadotropin dose during ovarian stimulation? (Please check all statements that apply to you)
  • I don’t change the gonadotropin dose during ovarian stimulation
  • I adjust the dose according to E2 levels
  • I adjust the dose according to LH levels
  • I adjust the dose according to P4 levels
  • I adjust the dose according to ultrasound data

 

Do you use blood E2 levels as indicators of OHSS risk, in general?
  • Yes
  • No

 

How do you decide on a freeze-all cycle for the prevention of OHSS in hyper-responders before ovulation triggering? (Check all that apply)
  • Based on ultrasound data
  • Based on blood hormone levels
  • Other

 

How do you decide on the timing of ovulation triggering? (Check all that apply)
  • Based on ultrasound data
  • Based on blood hormone levels
  • Based on the day of the week
  • Other

 

How do you plan the day of frozen- thawed embryo transfer during natural cycles? (Check all that apply)
  • I do an ultrasound check to confirm ovulation
  • I ask patients to check ovulation using a urine LH test strip
  • I ask patients to do a blood hormone check to predict ovulation and then confirm with an ultrasound
  • In case of hCG/GnRH-agonist triggering, I monitor with a blood hormone test and ultrasound

 

Do you check blood E2 levels during endometrium preparation for artificial/HRT FET cycles?
  • Yes, for all patients
  • Yes, for some patients
  • No

 

Do you check blood LH levels during endometrium preparation for artificial/HRT FET cycles?
  • Yes, for all patients
  • Yes, for some patients
  • No

 

Do you check blood progesterone levels during endometrium preparation for artificial/HRT FET cycles?
  • Yes, for all patients
  • Yes, for some patients
  • No

 

Do you use ultrasounds during endometrium preparation for artificial/HRT FET cycles?
  • Yes, for all patients
  • Yes, for some patients
  • No

 

Do you check blood progesterone levels just before embryo transfer in frozen thawed embryo transfer cycles?
  • Yes, for all/ nearly all patients
  • Yes, for some patients
  • No

 

Do you check blood progesterone levels during the luteal phase to ensure sufficient luteal phase support?
  • Yes, for all / nearly all patients
  • Yes, for some patients
  • No

 

To what extent do you agree with the following statement? (1 means fully disagree and 5 means fully agree).
  • I believe that blood hormone tests play an important role in monitoring ovarian response during ovarian stimulation for ART treatment
  • Blood hormone tests can be useful to guiding decision-making in adjusting the dose of gonadotropins.
  • Blood hormone tests are important to guiding decision-making in preventing OHSS
  • Blood levels of E2 and LH are clinically relevant to deciding when to start GnRH antagonists in flexible protocols

IVF-Worldwide Online Congresses: planning for future congresses

Following the success of the last five IVF-Worldwide Online Congresses, I wish to consult with you on planning for future congresses.

Please take a minute to answer the questions below, which will guide our activities in the near future.

As a follow-up on the April 2022 congress, attached is information of the demographic makeup of the participants.

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What is your specialty:
  • Physician
  • Embryologist
  • Nurse
  • Industry representative
  • Other

 

Did you participate in any of the five online congresses?
  • Yes
  • No

 

Did you recommend the congresses to your colleagues?
  • Yes
  • No

 

Should we continue with the congresses strictly online or in a hybrid format?
  • Online only
  • Hybrid format (both online and in person)
  • Face to face only

 

Would you be willing to pay a fee to attend an online congress?
  • Yes
  • No

 

Should we continue with the new recurring session: "Giants in Reproductive Medicine," in which we spotlight key people whose scientific advancements have contributed significantly to IVF developments?
  • Yes
  • No

 

Should we continue with the new recurring session: "MedFemTech," in which select companies present their current or future innovative solutions for women’s reproductive health?
  • Yes
  • No

 

Should we host more debates?
  • Yes
  • No

 

Should we offer a case analysis session?
  • Yes
  • No

Donor sperm - what do you recommend?

The use of donor sperm is on the rise worldwide for single women, same-sex couples, and heterosexual couples. In many cases, these are patients who have not ever attempted to conceive,  and do not, actually meet the accepted criteria for infertility. Besides pure medical considerations, other specific financial factors are involved including the cost of both donor sperm and fertility treatments.

Is sperm donation available in your country?
  • Yes
  • No

 

Yes

Please specify your profession
  • Clinician
  • Nurse
  • Embryologist
  • Other

 

Is your practice private or public?
  • Only private
  • Only public
  • Both, equally

 

How many patients utilize sperm donation in your practice per year?
  • Less than 10 patients
  • 10-50 patients
  • 51-100 patients
  • More than 100 patients

 

How many natural IUI cycles with donor sperm would you recommend to a 32-year-old patient with normal ovarian reserve assessment and no history of infertility?
  • Up to 3 cycles
  • Up to 6 cycles
  • Up to 9 cycles
  • Up to 12 cycles
  • I would not recommend a natural IUI cycle for this patient

 

What treatment would you recommend to a 32-year-old patient who did not conceive after natural cycle donor insemination?
  • Clomiphene or letrozole +IUI
  • Gonadotrophins + IUI
  • IVF
  • Other

 

How many natural IUI cycles with donor sperm would you recommend to a 37-year-old patient with normal ovarian reserve assessment and no history of infertility?
  • No more than 3 cycles
  • Up to 6 cycles
  • Up to 9 cycles
  • I would recommend gonadotropin / IUI treatment as first line treatment
  • I would recommend IVF as first line treatment
  • Other

 

How many gonadotropin - donor-IUI cycle would you recommend to a 37-year-old patient before proceeding to IVF?
  • Up to 3 cycles
  • 3-6 cycles
  • More than 6 cycles
  • None – I would recommend IVF as first line treatment
  • Other

 

How many natural IUI cycles with donor sperm would you recommend to a 40+-year-old patient with normal ovarian reserve assessment and no history of infertility?
  • No more then 3 cycles
  • Up to 6 cycles
  • Up to 9 cycles
  • I would recommend GT / IUI treatment as first line treatment
  • I would recommend IVF as first line treatment

 

A 37-year-old woman wants to conceive using donor sperm. She has no history or sonographic findings suggestive of tubal pathology. Would you refer for assessment of tubal patency, such as hysterosalpingography or hydrosonography?
  • Yes
  • No

 

How many inseminations per cycle do you recommend to 37-year-old women using donor sperm?
  • One
  • Two

 

How many inseminations per cycle do you recommend to a 37 year old whose partner has normal sperm parameters?
  • One
  • Two

 

To what extent do you agree with the following statements (1 = completely disagree and 5 = completely agree agree)
  • Patients seeking treatment with donor sperm should be offered identical treatment protocols to women attempting to conceive with a partner.
  • In women aged 40 and above who wish to conceive with donor sperm, natural cycle IUI is a "waste of precious time".
  • the cost of donor sperm vials should be an important consideration in the clinical management of women seeking treatment with donor sperm.
  • The efficacy of donor insemination is lower compared with intercourse among couples with normal sperm parameters.

Early pregnancy loss treatment

Early pregnancy loss (EPL) is defined as a nonviable, intrauterine pregnancy within the first trimester (either anembryonic pregnancy or embryonic death). Unfortunately, it is common in the general population, and even more prevalent among sub-fertile women undergoing fertility treatments.Misoprostol (Cytotec) is an accepted treatment for EPL worldwide. Despite its widespread use, there is no consensus regarding the optimal treatment protocol, and the common practice differs greatly between clinics.

What is your current position?
  • Ob/Gyn Resident
  • Ob/Gyn specialist
  • Fertility specialist
  • Other

 

In what type of setting do you treat patients with early pregnancy loss (EPL)?
  • Private clinic
  • Public clinic
  • University-affiliated clinic

 

In your opinion, what should be the first line of treatment in most women experiencing early pregnancy loss (EPL)?
  • Expectant management
  • Medical treatment
  • Surgical evacuation
  • I provide all relevant information and let the patient choose according to her own preference

 

How many patients with EPL do you treat every year?
  • 1-20
  • 21-51
  • 51-100
  • 101-200
  • More than 200

 

Do you use misoprostol for EPL treatment in your practice?
  • Yes
  • No

 

Yes

Where does misoprostol treatment take place?
  • At a medical facility
  • At the patient’s home

 

Up to what gestational size (according to transvaginal sonography) do you administer misoprostol for EPL?
  • 8-9 weeks
  • 10-12 weeks
  • 13-14 weeks
  • Other

 

In the majority of cases, which route of misoprostol administration do you use?
  • Vaginal
  • Sublingual
  • Oral
  • Other

 

Which dose of vaginal/sublingual/oral/other misoprostol do you use?
  • 400 mcg
  • 600 mcg
  • 800 mcg
  • Other

 

When do you schedule the first follow-up visit?
  • After 24 hours
  • After 2-3 days
  • After 4-6 days
  • After one week
  • After two weeks
  • More than two weeks

 

In case of incomplete expulsion, do you administer a second dose of misoprostol?
  • Yes
  • No, I recommend surgical evacuation
  • I provide counselling and the patient chooses whether or not to receive a second dose according to her own preference.

 

When do you make the final decision regarding treatment failure or success?
  • After 24 hours
  • After 2-3 days
  • After 4-6 days
  • After one week
  • After two weeks
  • After one month
  • After the first menstrual period
  • Other

 

What are your sonographic criteria for successful treatment?
  • No gestational sac (regardless of endometrial thickness).
  • No gestational sac and endometrial thickness is less than 30 mm
  • No gestational sac and endometrial thickness is less than 20 mm
  • No gestational sac and endometrial thickness is less than 15 mm
  • No signs of residual products of conception.
  • Other
  • I do not perform a sonographic follow-up.

 

Do you combine misoprostol treatment with any other medications?
  • No
  • Yes, mifepristone (Mifegyne) pretreatment
  • Yes, methotrexate
  • Yes, oxytocin
  • Other

 

In your opinion, what is the level of evidence regarding misoprostol treatment for EPL?
  • Highest level of evidence
  • Moderate level of evidence
  • Low level of evidence. More studies are needed.

 

I would like to see more research data about the following issues (multiple answers allowed):
  • Misoprostol dose
  • Misoprostol route of administration
  • Mifepristone pretreatment
  • Timing and effectiveness of a second dose administration
  • Criteria to decide on treatment failure of success
  • Comparison between misoprostol and surgical evacuation
  • Long-term consequences of misoprostol treatment
  1. Survey - Use of endometrial scratching in IVF/IUI
  2. Results - Use of endometrial scratching in IVF/IUI
  3. Results- Are you transferring aneuploid/mosaic embryo?
  4. survey - Are you transferring aneuploid/mosaic embryo?

IVF Worldwide Surveys

 

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