15. No Down Regulation
• Start day 2-3 of the cycle
• Dose: 75-300 IU/day depending on:
Ovarian reserve
Age
Previous response
PCOs
16. Monitor by:
• TVUS
• Serum E2
Usually
• 8-10 days
• one or more follicle >17 mm
• hCG 10,000 IU
Luteal support:
• No need.
• Or micronized progesterone.
17. Down regulation:
• COH for ART: IUI, IVF, ICSI
• Benefits:
– Prevent premature LH surge.
– Better quality of oocytes.
– Scheduled oocyte pickup.
• Starts at least 5 days before expected date of
menses.( Long Luteal )
• 1st day of menses.( Long Follicular )
• Long acting GnRh agonist
• Short acting GnRh agonist daily dose till hCG day.
18. Down regulation:
• E2<50 pg/ml
• Dose: 225-300 IU/day
• Monitor with TVUS & serum E2
• Adjust the dose: ↑or ↓ after 4- 5 days.
• 3 follicles or more > 17 mm
• Stop agonist
• hCG 10,000 IU
• OPU 34-36 hours after hCG
• IUI 36-48 hours after hCG.
• Luteal Support
26. Antagonist protocol:
• Start hMG on day 3 of menses.
• Antagonist when follicle reach 14-15 mm
– Long acting ( single injection )
– Short acting (Daily usually 3-4 injections).
• hCG 10,000 when 3 or more follicles > 17mm
• OPU 34-36 hours
• Luteal Support
30. Poor Responders
• 3 or less follicles
• What to do?
1- short protocol (flare up protocol)
2- Antagonist protocol.
3- No down regulation
4- COCpills + short protocol
5- Comiphene citrate
35. What to do:
–Soft protocols.
–Coasting
–Metformine
–Cabergolin
–Antagonists
–Cancellation (no hCG)
–No ET
36. • Ultra short, highly economic and effective
protocol for ICSI patients.
• El Deeb M.W, Sami S, Sallam A, Ismail E,
Mohsen E, Darwish Y, El Sharaki A.
• INTEGRATED FERTILITY CENTER,
ALEXANDRIA, EGYPT.
37. Keeping things simple without
altering success rate of ICSI is
the idea behind our novel
protocol. This simple protocol
aims to reduce the burden of
ICSI procedures and its related
complications, thereby giving a
couple the chances to conceive
using procedures less costly in
terms of physical, emotional,
social and financial costs.
38. We had 65 cases underwent ICSI, their
age ranges from (23-47) years.
Clomiphene citrate (CC ),3 tablets daily
started from the second day of the cycle
for 5 days, In the last day of CC
administration HMG was given in the
form of 2 amps of Menegon 75 (Ferring)
or Merional 75 (Ibsa) + 2 amps of Gonal
F 75 ( Merck Serono) , till we reach one
or more follicles > 16 mm. E2 is
measured.
39. Next day early morning one
amp. Of Cetroide 0.25 mg. and
the full HMG dose was
received… HCG 10,000 was
administrated when one or
more follicles > 18 m.m as usual.
40. Average number of oocytes
retrieved ranges from (2-25)
oocytes, number of embryos
transferred (ET) ranges from (1-
5) embryos, only one case had
no ET. We had 25 pregnant
cases 38.4 % five of them had
blastocyst transfer.
41. These encouraging results of
this highly economic protocol
should be put in
consideration as a simple and
successful ICSI protocol.