פורום טיפולי פוריות - עמוד 2356

בדיקת הדם רגישה יותר מבדיקת השתן ,רצוי להמתין 12 יום מההחזרה

אין עם זה בעיה

במרבית העבודות שנעשו עד היום שרובן רטרוספקטיביות לא נמצאה העדפה לשיטת הטיפול להחזרת מוקפאים -במחזור טבעי או טיפולי ,כעת נערך מחקר גדול פרוספקטיבי שאת תוצאותיו נראה בקרוב ,להלן המחקר: Cryo-thawed embryo transfer: natural versus artificial cycle. A non-inferiority trial. (ANTARCTICA trial). AuthorsGroenewoud ER, et al. Show all Journal BMC Womens Health. 2012 Sep 5;12:27. doi: 10.1186/1472-6874-12-27. Affiliation UMCG, Groningen, The Netherlands. e.r.groenewoud@umcg.nl Abstract BACKGROUND: Frozen thawed embryo transfer (FET) is a cost-effective adjunct to IVF or IVF-ICSI treatment. In order to optimize treatment outcome, FET should be carried out during a period of optimal endometrial receptivity. To optimize implantation several methods for endometrium preparation have been proposed. In natural cycle FET (NC-FET), the endometrium develops under endogenous hormonal stimulation. The development of the dominant follicle and endometrium is monitored by ultrasound and FET is timed after triggering ovulation induction or determination of the spontaneous LH surge. In an artificial cycle FET (AC-FET) estrogens and progesterone are administered to prepare the endometrium for implantation. While the currently available data show no significant difference in pregnancy rates between these methods, well designed randomized controlled trials are lacking. Moreover there is little literature on difference in cancellation rates, cost-efficiency and adverse events. METHODS AND DESIGN: In this randomized, multi-centre, non-inferiority trial we aim to test the hypothesis that there is no significant difference in live birth rates between patients undergoing NC-FET versus AC-FET. The primary outcome will be live birth rate per embryo transfer procedure. Secondary outcomes will be ongoing and clinical pregnancy rate, cancellation rate, (serious) adverse events and cost-efficiency. Based on a live birth rate of 20% and a minimal clinical important difference of 7.5% (one-sided alpha 2.5%, beta 20%) a total of 1150 patients will be needed. Analyzes will be performed using both per protocol as well as intention to treat analyses. DISCUSSION: This prospective, randomized, non-inferiority trial aims to address the hypothesis that there is no significant difference in live birth rates between patients undergoing NC-FET versus patients undergoing AC-FET. Moreover it addresses cost-efficiency as well as the perceived burden of both treatments. TRIAL REGISTER: Netherlands trial register (NTR): 1586.

אינני רואה כל סתירה ומניעה בביצוע שני הטיפולים בעיתויים חופפים או נפרדים

שלום רב בנתונים שנמסרו הייתי מעדיף פרוטוקול קצר או טבעי-MNC ,היות ופרוטוקול ארוך עלול להכניס את השחלה לדיכוי עמוק ביותר שכדי להחלץ מימנו תזדקקי לכמויות אדירות של גונדוטרופינים ואם בכלל.

את הבדיקה ניתן לבצע בימים 2-5 למחזור ,לפני נטילת גונל

חלוקת העוברים בהחלט נותנת סיכוי להריון. באשר לתמיכה: לכל רופא יש פרוטוקולים שהוא מאמין בהם. אינני רוצה להתערב בפרוטוקולים של הרופא שלך, מה גם שהתמיכה ניראית ראויה

לא מובן מאליו!

הטיפול בגונל להשריית ביוץ מותאם אישית individually adjusted dose וכל הסיכויים שיושג לפני המועד הנקוב

ערך נמוך זה בסדר,ולכן החריגה חסרת משמעות

סליחה עוד פעם על השאלה אבל למה התוצאות (רוגסטרון פחות מ1.7 וטסטוסארון פחות מ0.9) מסומנות בצבע אדום (כאילו הן בחריגה)? הבדיקה בוצעה ביום השלישי של המחזור. תודה

תוצאות אלו תקינות לחלוטין

במצבים אלו יתכן גם חסרים בכרומוזום Y.להלן המאמר Y chromosome AZFc deletions present in 45X/46,XY chromosomal mosaic patients with Turner stigmata and sexual ambiguities: consequences for ICSI? AUTHOR(S)Patsalis, P. C.; Sismani, C.; Ioulianos, A.; Eftychi, C.; Krausz, C.; Fatima; Quintana-Murci, L.; McElreavey, K. PUB. DATEMarch 2002 SOURCEReproductive BioMedicine Online (Reproductive Healthcare Limited;2002 Supplement 2, Vol. 4 Issue S2, p46 SOURCE TYPEAcademic Journal DOC. TYPEAbstract ABSTRACTObjective: Microdeletions of the long arm of the human Y chromosome define three non-overlapping regions termed AZF (AZoospermia Factor) which cause male infertility. Advances in infertility treatment permit deleted Y chromosomes to be transmitted to male offspring with the assumption that there will be no clinical consequences other than infertility in adult life. Recently it was demonstrated that a subgroup of infertile men, with AZFc deletions, exhibits a 45,X/46,XY chromosomal mosaicism in peripheral blood lymphocytes. Some of these men were oligozoospermic and in their germ cells a significant proportion of cells were found to be nullisomic for gonosomes, indicating considerable Y chromosome loss during spermatogenesis in this group of men. These data suggested that sex chromosome mosaicism could arise when AZFc-deleted Y chromosomes are transmitted from one generation to another by intracytoplasmic sperm injection (ICSI). If this hypothesis is correct, it raises the possibility that some patients with 45,X/46,XY karyotypes, such as patients with Turner-related phenotypes or sexual ambiguities, may in fact harbour Y chromosome microdeletions. To test this hypothesis, a group of patients with a 45,X/46,XY karyotype was screened for Y microdeletions. Materials/Methods: A group of 12 patients with a 45,X/46,XY karyotype detected in routine cytogenetic screening of metaphase lymphocytes for Y chromosome microdeletions was screened. All of these patients exhibited sexual ambiguities (partial gonadal dysgenesis, streak gonad(s), immature testicule, ovarian-like structures, hypospadias, cryptorchidism) as a consequence of the lack of Y chromosome-bearing cells in the gonad, and/or were diagnosed as having somatic anomalies characteristic of Turner syndrome (short stature, cardiac anomalies, complete Turner stigmata). The Y chromosome was considered intact by conventional cytogenetic techniques in all cases. Twelve cases with a 45,X/46,XY karyotype for Y chromosome microdeletions were screened by polymerase chain reaction (PCR), using 12 Y-specific markers. Results: Four cases (33%) were identified, each with a complete AZFc deletion. All had deletions for the AZFc markers sY152, sY254 (DAZ gene family). Negative results were repeated at least three times and in two cases a Southern blot was performed using the DAZ gene as a probe: the AZFc deletions were confirmed. In two cases the DNA of the father was available for testing. The PCR results were positive for all of the Y chromosome markers, including the AZFc region, suggesting that either the deletions are de novo or that they are present at low mosaicism in the lather. Conclusions: A total of 33% of patients presenting with Turner stigmata and/or sexual ambiguities and a 45.X/46,XY karyotype, carried Y chromosome microdeletions of distal Yq. These results highlight a potential risk for offspring born to fathers carrying Y chromosome microdeletions and treated by assisted reproductive techniques. The risk is the development of sex chromosome aneuploidy during fetal and embryonic development. The clinical consequences of this can be severe, including Turner syndrome, mixed gonadal dysgenesis, male pseudohermaphroditism and, rarely, mild mental retardation or autism. The data may also explain in part the observation that in almost three-quarters of all 45,X patients with Turner syndrome, the X chromosome is maternal in origin, Follow-up studies on children conceived by men with Y chromosome microdeletions by the ICSI is recommended. The transmission of Y chromosome microdeletions could potentially have more severe clinical consequences other than male infertility, such as the development of sexual ambiguities and/or Turner stigmata.