Inducción ovulación gonadotropinas y la mejora de resultados : analisis1400 ciclos Dr.José Arturo Mora Rodriguez Residente 2 año de Biologia de la reproducción Profesor Titular: Dr. Hector Godoy Morales Profesor Adjunto :Dr. Alfredo Ulloa Aguirre

INtroducción IO/OE con Gonadotropinas tx 1960-1980 Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Objetivo Embarazo alto orden fetal Reducir las perdidas fetales The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertility and Sterility Vol. 92, No. 5, November 2009

Embriones Día 3 Día 5 The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertility and Sterility Vol. 92, No. 5, November 2009

Mujeres ‹ 35 años TE Un solo embrión. Clivaje o blastocisto debe ser transferido The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertility and Sterility Vol. 92, No. 5, November 2009

Mujeres de 35 a 37 años No mas 2 embriones en estado de división No mas de 2 blastocistos The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertility and Sterility Vol. 92, No. 5, November 2009

Mujeres de 38 a 40 años 3 embriones en etapa-división 2 blastocistos The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertility and Sterility Vol. 92, No. 5, November 2009

Mujeres de 41-42 años 5 embriones en etapa-división. 3 blastocisto The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertility and Sterility Vol. 92, No. 5, November 2009

Mujeres 43 años No hay limite embriones The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertility and Sterility Vol. 92, No. 5, November 2009

Obejtivo Maximizar tasas de embarazo Minizar embarazos multiples Edad paciente Concentración de E2 Desarrollo folicular Dosis de Gonadotropina Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Objetivo Tasa de embarazo Tasa de embarazo alto orden fetal Tasa de aborto Tasa de nacidos vivos Tasa de nacidos vivos de embarazo de alto orden fetal peso de nacidos de embarazo orden fetal Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Material y metodos Agosto 1998 a diciembre 2008 Estudio retrospectivo Incluyeron 1574 ciclos Instituto Jones (Unidad Medicina Reproductiva ) Norfolk , virginia Agosto 1998 a diciembre 2008 Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Material y metodos Criterios exclusion Perdida de embarazo recurrente Numero ciclos x paciente de 1 a 12 con una media de 2.2 Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Material y metodos Evaluacion infertilidad - E2, FSH , LH , TSH , Prl( 3 día ) - Histerosalpingografia ( Permeabilidad ) - Espermatobioscopia Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Material y metodos Problemas tiroideos y con hiperprolactinemia se inicio tratamiento. Miomas submucosos fueron extirpados Infertilidad masculina severa - Evalucación urológica - Pruebas Geneticas ( Cariotipo anormal o microdelecciones de Y ) Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Material y metodos Estimulo con gonadotropinas ( con o sin citrato de clomifeno ) fue seguido con CP o IIU Uso de AGnRH pacientes con alto riesgo de luteinización ( SOP o elevacion de LH en ciclo previo ) Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Material y metodos Uso de Gonadotropinas urinarias y recombinantes sola o en combinación con LH en estados hipogonadismo hipogonadotropico. Dosis inicial 25 UI FSH Step-Up Edad paciente Diagnostico infertilidad Respuesta ciclos previos Decidir inicio de dosis y aumento Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Material y metodos USG Basal y E2 ( Quiste funcional ) Examen ecografico cada 1-4 días con concentraciones de E2 y LH Cancelación de ciclo falta respuesta 6-8 días 3 foliculos de mas de 16 mm y E2 mayor de 1500 pg/ml Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Analisis estadistico SAS Version 9.1

Resultados Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011

Abbaa Sarhan. Gonadotrophin ovulation induction and enhancement outcomes: analysis of more than 1400 cycles Reproductive BioMedicine Online 2011