IVF Protokoli /poor responderi/fsh-ovke/

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Počalji od mona taj 13/5/2010, 20:03

pozdrav cure ovdje sam nova i treba mi pomoc......plzzzz

danas sam isla po lijekove za ivf moj 1. dobila sam menopure i dec.
moj fsh je u 10mj. bio 10 sad je 13,60.....
dali je to dobra stimulacija za mene?? i kolike su mi uopce sanse sa tom stimulacijom? dali smijem ici na stimulaciju sa visokim fsh? hvala
mona
mona

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Počalji od dr mali pariz taj 13/5/2010, 20:07

Mona,pa mnogo su školovaniji oni što su ti ga prepisali,od nas koji bismo sudili.
Jeste ti fsh visok,ali se nadam da će to biti dobro za tebe.
Gde radiš,i koliko gonala dnevno?

_________________
ja '78.g.
m.m. '71.g.
2x IVF beta 0
1x ICSI  beta 1,87
4. postupak ICSI+PICSI+hatching PFC dr Sonja
16. dan beta 1931

ispod maminog , kucaju još IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 0913 IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 0913
Bog će nam dati sve u svoje vreme ; onako i onoliko, kako i koliko nam je nužno , za naše spasenje.
16.jul, Zvezde su rodjene!
Lilypie Fifth Birthday tickers
dr mali pariz
dr mali pariz

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Počalji od mona taj 13/5/2010, 20:43

hr..Sveti Duh....2-4 dc 3x menopuri a ne gonali......4-5 dc 2x menopuri....
dr.nije znao za ovaj novi nalaz 13,60 samo za onaj od 10 mj. 10
moram ga zvati i javit mu ali eto pitam za vase misljenje vi ipak imate iskustva sa visokim fsh
mona
mona

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Počalji od dr mali pariz taj 13/5/2010, 20:51

da,menopur,sorry.
nije ti jaka terapija,ali možda bi i trebalo da mu javiš,možda ti nešto i promeni.
Ima ovde podforum sa problemom FSH,pa poseti tamo i postavi pitanje,tamo će devojke koje imaju visok FSH rado odgovoriti na tvoje pitanje.
http://kutak.forumotion.com/povisen-fsh-f51/

_________________
ja '78.g.
m.m. '71.g.
2x IVF beta 0
1x ICSI  beta 1,87
4. postupak ICSI+PICSI+hatching PFC dr Sonja
16. dan beta 1931

ispod maminog , kucaju još IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 0913 IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 0913
Bog će nam dati sve u svoje vreme ; onako i onoliko, kako i koliko nam je nužno , za naše spasenje.
16.jul, Zvezde su rodjene!
Lilypie Fifth Birthday tickers
dr mali pariz
dr mali pariz

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Počalji od mona taj 13/5/2010, 21:07

ma sad je kasno za promjenit vjerovatno, jer sam daleko od njih 4h voznje ....jedino kad dođem 7dc na folikulometriju mozda onda promjeni..ubaci nesto...uglavnom moram dr. javit nije to bas za zezat se...povisen je za skoro 4.....hvala
mona
mona

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Počalji od lena taj 13/5/2010, 21:14

mona, nije to strasno visok FSH.
menopur je sasvim ok.
ako se dobro secam, dr radoncic iz zg, koji je tebi verovatno poznat, kaze da je menopur pola FSH a pola LH, dok je gonal cist FSH...
lena
lena

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Počalji od nabla taj 13/5/2010, 21:23

Mona, fsh od 10 je tvojim docovima vec bio indikator za odredjivanje terapije. Fsh od 10 i 13 su prakticno vrednosti koje su u istom rangu- nije to velika razlika.
Pretpostavljam da na Sv. Duhu rade UZ na pocetku ciklusa i da terapiju odredjuju prema izgledu jajnika.
Meni se cini da je terapija sasvim OK.

Tvoja reakcija ce vise zavisiti od toga koliko imas antralnih folikula i od toga koliko imas godina, nego od toga koliki ti je fsh. Fsh je varljiva kategorija!
nabla
nabla

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Počalji od mona taj 13/5/2010, 21:37

hvala vam cure ....kako sam danas vidjela nalaz tako sam plakala, sokirala se....sad mi je lakse....dr. mi je rekao da dođem tek 7dc na ultrazvuk....znaci menopur nije los izbor.?
i da imam i one decap. od 1dc do 7dc po jednu
mona
mona

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Počalji od lena taj 13/5/2010, 21:42

samo se ti opusti i uzivaj i - napred sa menopurima! IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 Lol
lena
lena

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Počalji od aha taj 14/5/2010, 08:51

mozda ti je skocio FSH ako si uzimala kontracepciju pre ovog ciklusa... desava se i to ponekad...i srecno!
aha
aha

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Počalji od mona taj 14/5/2010, 12:01

uzimala sam ja klomifene i femaru , 12 mj, 1mj, 2,mj, 3mj, jer sam bila na AIH....e sad ne znam jeli do toga....
znate sta danas kupim suve smokve i maslinovo ulje i probam malo s tim....
mona
mona

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Počalji od dr mali pariz taj 14/5/2010, 14:00

Mona,dobra je to stvar sa smokvama..

_________________
ja '78.g.
m.m. '71.g.
2x IVF beta 0
1x ICSI  beta 1,87
4. postupak ICSI+PICSI+hatching PFC dr Sonja
16. dan beta 1931

ispod maminog , kucaju još IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 0913 IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 0913
Bog će nam dati sve u svoje vreme ; onako i onoliko, kako i koliko nam je nužno , za naše spasenje.
16.jul, Zvezde su rodjene!
Lilypie Fifth Birthday tickers
dr mali pariz
dr mali pariz

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Počalji od Struzzo taj 14/5/2010, 21:20

Dobrodosla mona! IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 490909
Nemoj da se opterecujes cifrom FSH, pogotovo sad kad si u postupku.Ne primas puno ampula, ja sam imala po 5-6 ampula Menopura dnevno.
Mozes da koristis smokve u maslinovom ulju...nece da skodi. Potopi ih u kvalitetno extra vergine, uzimaj 1-2 smokve ujutro na prazan stomak, neposredno posle nemoj odmah nesto piti ili jesti...Ako nista drugo, dobro je za regulisanje stolice. IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 Icon_wink
Hajde, navijam!
Javljaj nam kako napredujes!
Struzzo
Struzzo

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Počalji od nena beba taj 23/5/2010, 23:50

da povucem i moje poor responderke... zelim da i vama krenu ti folikuli pa onda lepe jajne celije i embrioni-i da uskoro nunate bebice!
nena beba
nena beba

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Počalji od Orline taj 24/5/2010, 08:52

Ihaj, nensi, kasnis...Mi vec poskocile na odbrojavanju IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 Icon_lol
Orline
Orline

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Počalji od djole42 taj 31/5/2010, 13:47

nabla ::Evo nesto za POF

Hronicno povisen fsh (u menopauzalnom rangu) uspavljuje receptore za fsh. Pobudjivanje receptora se moze postici na 2 nacina:
1) upotrebom estrogena koji suprimira oslobadjanje fsh
2) supresijom lucenja hormona koji oslobadja gonadotropin (gonadotropin releasing hormone (GnRH)) koriscenjem GnRH agonist leuprolide acetata

Procedura podrazumeva upotrebu 2,5-5 mg konjugovanog? estrogena par nedelja dok se fsh ne spusti u normalu, a zatim sledi upotreba niskih doza hMG (75-150 IU dnevno).
S konjugovanim estrogenom se moze nastaviti i nakon pocetka primene hMG-a (u tom slucaju rekacija se prati samo UZ) ili prekinuti (u tom slucaju se razvoj folikula prati UZ i pracenjem nivoa E2)

Etinil estradiol
Prvi slucaj uspesne indukcije ovulacije kod POF-a upotrebom etinil estradiola zabelezena je 1989. god. kod zene stare 39. godina sa deficitom E2 i fsh od 124.
Pre primene hMG-a (150 IU dnevno) izvrsena je supresija bazalnog fsh primenom etinil estradiola. Ta zena je imala ovulaciju narednih 6 ciklusa, u sestom ciklusu je zatrudnela.
Da li je ovo EPP (estrogen priming protocol)?Ima li neko informaciju da li se on primenjuje kod nas i u kojoj klinici i da li je neka bila na ovom protokolu?
djole42
djole42

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Počalji od nabla taj 31/5/2010, 14:24

Djole, ja sam ispala iz stosa, mada sam oduvek bila slaba sa tom strucnom klasifikacijom lekova.

Na tom protokolu (po rednim br. 1) koji si citirala bila je BlackMagicWoman, ali ona je dugo u menopauzi i fsh joj se kretao oko 100-ke. Tim protokolom su uspeli da probude jajnike, ali folikul je rastao samo do oko 13 mm i posle je usahnuo. Znam da je po tom pitanju kontaktirala Radoncica, i da joj je dao obrazlozenje zasto to nije uspelo. Ne secam se vise tacno, ona bi ti to bolje objasnila. Potrazi na Radoncicevom sajtu njeno pitanje i njegovo objasnjenje.
Taj protokol je opisao i upotrebljavao dr Check koji se bavim IVF-om kod fsh-ovki. I imao je uspeha. BlackMagicWoman je taj protokol isprobala pod nadzorom dr Vujovic (par ciklusa).

Pretpostavljam da si vec googlala na tu temu, i ja sam sad malo pa nadjoh nesto...mozda nekom koristi
Estrogen priming protocols: Older women (over 40 yrs), women who have demonstrated a prior reduced ovarian response to COH and those who by way of significantly raised cycle day 3 FSH and reduced Inhibin B levels are considered likely to be “poor responders”, are first given GnRH agonist for a number of days to effect pituitary down-regulation. Upon menstruation and confirmation by ultrasound blood estradiol measurement that adequate ovarian suppression has been achieved, the dosage of GnRH agonist is drastically lowered (or the agonist is replaced with a GnRH antagonist) and the woman is givens twice-weekly injections of estradiol for a period of 7-10 days. COH is then initiated using a relatively high dosage of FSH-dominant gonadotropins such as Folistim or Gonal F that is continued along with daily administration of GnRH agonist/antagonist until the “hCG trigger”. A recently completed study has demonstrated the efficacy of this protocol and the ability to significantly improve ovarian response to gonadotropins in many of hitherto “resistant patients


Na osnovu ovog opisa meni se ne cini da je ono sto si citirala Estrogen priming protocol. Pre bi to bila neka varijanta "dugog" protokola, dakle suprotno od citiranog jer se spominje ovarijalna supresija.

The GnRH Agonist/Antagonist Conversion Protocol (A/ACP) : It is our position that some form of pituitary blockade, either in the form of a GnRH agonist (e.g. Lupron, Buserelin, Nafarelin, and Synarel. Decapeptyl) or a GnRH antagonist (e.g. Antagon, Cetrotide, Cetrorelix, and Ganarelix) is an essential component in ovarian stimulation of “poor responders” undergoing IVF. If this is not done, a progressive rise in LH –induced ovarian androgens (male hormones ….mainly testosterone) will inevitably affect follicle/ egg development, resulting in compromised embryo quality.
The follicles/ eggs of women on GnRH-agonist “flare protocols” are exposed to an exaggerated Lupron-induced LH release, (the “flare effect” while the follicles/eggs of women, who receive GnRH antagonists starting 6-8 days into the stimulation cycle are exposed to endogenous LH -induced ovarian androgens( especially testosterone). This might not be problematic in “normal responders” but could be decidedly prejudicial in “poor responders” and older women where endogenous basal LH levels are often raised and the ovaries may be inordinately sensitive to LH and where excessive exposure of follicles and eggs to testosterone could severely compromise egg development and thus embryo quality.
exhausted of its LH and residual minimal LH is present in the circulation by the time stimulation with gonadotropins begins, the above mentioned adverse testosterone-effect is largely negated. On the down side is the fact that prolonged administration of GnRH agonists such as Lupron (such as with the GnRH agonist down-regulation protocol could suppress subsequent ovarian response to ovarian stimulation with gonadotropins, by competitively binding with ovarian FSH receptors. We introduced of our Agonist/Antagonist Conversion Protocol (A/ACP) more than a year ago in an effort to counter this effect.


With the A/ACP, low dose Antagon/Cetrotide is commenced at the onset of spontaneous menstruation or following bleeding that follows initiation of GnRH agonist (e.g. Lupron) therapy using a long-down-regulation protocol arrangement. We currently prescribe the A/ACP to most of our IVF patients regardless of whether they are “normal responders” or “poor responders”. Preliminary results suggest a significant improvement in egg number, egg/embryo quality as well as in implantation and viable IVF pregnancy rates. The A/ACP has however, proven to be most advantageous in “poor responders” where additional enhancement of ovarian response to gonadotropins may be achieved through incorporation of “estrogen priming”. We have reported on the fact that the addition of estradiol for about a week following the initiation of the A/ACP, prior to commencing FSH-dominant gonadotropin stimulation appears to further enhance ovarian response, presumably by up-regulating ovarian FSH-receptors.


There is one potential draw back to the use of the A/ACP, in that the sustained use of a GnRH antagonist ( e.g. Antagon/Cetrotide) throughout the stimulation phase of the cycle, appears to compromise the predictive value of serial plasma estradiol measurements as a measure of follicle growth and development in that the estradiol levels tend to be much lower in comparison to cases where agonist (Lupron) alone is used or where a “ conventional” GnRH antagonist protocol is employed ( i.e. antagonist administration is commenced 6-8 days following initiation of gonadotropin stimulation). Rather than being due to reduced production of estradiol by the ovary(ies), the lower blood concentration of estradiol seen with prolonged exposure to GnRH-antagonist, could be the result of a subtle, agonist-induced alteration in the configuration of the estradiol molecule , such that currently available commercial kits used to measure estradiol levels are rendered much less sensitive/specific. Thus when the A/ACP is employed, we rely much more heavily on ultrasound growth of follicles along with observation of the trend in the rise of estradiol levels, than on absolute estradiol values. Thus we commonly refrain from prescribing the A/ACP in “high responders” who are predisposed to the development of severe ovarian hyperstimulation syndrome (OHSS) and accordingly where the accurate measurement of plasma estradiol plays a very important role in the safe management of their stimulation cycles.


It is remarkable, that while using the A/ACP + "estrogen priming " in “poor responders “ whose FSH levels were often well above threshold limits, the cycle cancellation has consistently been maintained below 10% ( i.e. much lower than expected). Many of these patients who had previously been told that they should give up on using their own eggs, and switch to ovum donation because of “poor ovarian reserve”, have subsequently achieved viable pregnancies at SIRM using the A/ACP with “estrogen priming”.


Poslednji izmenio nabla dana 2/6/2010, 23:56, izmenjeno ukupno 1 puta
nabla
nabla

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Počalji od nabla taj 31/5/2010, 14:40

na ovom linku se nalazi transkript razgovora sa Dr. Levine o poor responderima i protokolima

http://www.inciid.org/article.php?cat=&id=420
nabla
nabla

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Počalji od djole42 taj 31/5/2010, 15:12

Hvala Nabla srce si osmeh srce
djole42
djole42

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Počalji od mona taj 11/6/2010, 12:16

eeeee curke da vam javim novosti imala sam sa onom stimulacijom 7-8 folikula 5 js 3 oplođene 3 dobra embrija vracena jucer......cekam betuuu.....pozzzzz moj strah zbog visokog fsh je prosao jer sam dobro reagirala i imala odlicne js----pozzzzz
mona
mona

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Počalji od Struzzo taj 11/6/2010, 12:51

Super Mona!!!!! IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 512172 Navijam!!! IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 97392 IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 97392 IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 97392
P.S. Podseti me sta si i koliko ampula dnevno imala kao stimulaciju?
Struzzo
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Počalji od uporna taj 11/6/2010, 13:17

Bravo Mona!
Navijam da se lepo ugnjezde kod mame! IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 216281 IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 216281IVF Protokoli /poor responderi/fsh-ovke/ - Page 7 216281
uporna
uporna

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Počalji od tuli taj 11/6/2010, 13:36

Mona,superiska
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tuli
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Počalji od Masha UK taj 11/6/2010, 14:34

Bravo Mona. Samo tako - misli pozitivno. Nadam ce da ce i ishod biti isti.

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Masha UK
Masha UK

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Počalji od mona taj 11/6/2010, 15:39

1dc - 9dc decapeptyl po jedna svaki dan.......menopuri od 2dc do 4dc po 3 dnevno od 5-9 po 2 menopura....
mona
mona

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