Panel Discussion

1
Why Gonadotrophin considered as First Line

Treatment for PCOS Patients?

 1
Why Gonadotrophin considered as First Line

Treatment for PCOS Patients?

• CC resistance

• Shorten time to live birth

• Limited efficacy of Letrozole

 2
How to stimulate with Gonadotrophins in

daily practise for PCOS patients

 2
How to stimulate with Gonadotrophins in

daily practice for PCOS patients?

• Protocol : Chronic low dose protocol, low dose,

combined with CC
Chronic low dose-step up protocol

• Increase dose if necessary, after 14 days of low-dose stimulation

• The increment interval is not more than 7 days

Homburg R. Low dose gonadotrophin therapy for ovulation induction. 2014

 PROTOKOL GONADOTROPIN
HCG IIU
USG USG USG USG
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
FSH FSH FSH FSH FSH FSH FSH FSH FSH FSH FSH

• FSH 75 IU/hari
• USG hari ke 6
• jika folikel > 12 mm: dosis FSH sama, lakukan USG ulang 2-3 hari,
• jika folikel < 12 mm: dosis FSH dinaikkan 150 IU/hari, USG ulang tiap 2-3
hari.
• USG hari ke 12, jika folikel < 15 mm dosis FSH dinaikkan 225 IU/hari,
jika folikel > 15 mm dosis dilanjutkan
• Saat folikel berukuran 17-18 mm + ketebalan endometrium 9-10 mm
suntikan HCG
7
PROTOKOL GONADOTROPIN DOSIS SELANG
SEHARI
HCG IIU
USG USG USG USG
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
FSH FSH FSH FSH FSH FSH

• Dosis FSH 75 IU/hari

• Bila didapat folikel >12 mm pada hari ke-6 siklus haid,
maka dosis FSH dipertahankan
• Bila didapat hasil sesuai target pada hari ke-12, ovulasi
dipicu dengan hCG 5000-10000 IU
SEBERAPA BAIK HASIL GONADOTROPIN?
Kehamilan klinis
30
25.9
25

20

15 13.8 recombinant FSH

12.5
urinary FSH
10
hMG
5

0
recombinant urinary FSH hMG
FSH
Demirol A, Gurgan T. Comparison of different gonadotrophin preparations in intrauterine insemination
cycles for the treatment of unexplained infertility: a prospective, randomized study. Hum Reprod
2007;22(1):97-100
 2
How to stimulate with Gonadotrophins in

daily practice for PCOS patients?

• How to individualized Gonadotrophin use in PCOS

• Patient with Amenorhea: withdrawal or not?

• Controversies in OCP before stimulation

 3
Tips and Tricks to increase efficacy of

Gonadotrophins and How to Monitor?

 3
Tips and Tricks to increase efficacy of

Gonadotrophins and How to Monitor?

• Use Metformin
• Mastering USG monitoring instead of hormonal monitoring
• Determine fertilization method, tubal condition and sperm analysis
• How to reduce cost by using combination of Gonadotrophin and CC
 PROTOKOL KS & GONADOTROPIN
HCG IIU
USG USG USG USG
FSH FSH FSH FSH FSH FSH FSH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
KS KS KS KS KS

• klomifen sitrat 100 mg per hari

• FSH 75 IU mulai diberikan pada hari ke-6
• hCG diberikan dengan dosis 5000 - 10000 IU
bila folikel>17 mm
 Conclusion
• Gonadotrophin can be used as First Line treatment for PCOS
patients due to:
• Higher success rate vs CC/Letrozole
• Shorten Time To Live Birth
• Full dose Gonadotrophin is better than combination
• Must do good monitoring
• Counseling
• Informed consent from patient