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
