Abstract:
Two-round Delphi study carried out in Spain. Three theme-based blocks were set out: 1) Patient profiles: therapeutic goal and parameters to be analysed according to POSEIDON patient profiles; 2) Ovarian stimulation protocols with antagonists: monotherapy (FSH) vs combined therapy (FSH + LH/HMG); 3) Safety and effectiveness of the devices. The antral follicle count and the anti-Müllerian hormone level were considered indicators that can be used to predict ovarian response. More than 80% of the participants agreed that FSH monotherapy is the recommended regimen in normal/hyper-responsive patients of < 35 years of age; that 150-300 IU is the dose to be used in ovarian stimulation in monotherapy depending on clinical parameters; and that FSH monotherapy improves patients\' comfort compared to two combined drugs. It was unanimously considered that the type of device used by the patient influences the comfort of the treatment.IMPACT STATEMENTWhat is already known on this subject? There is currently no consensus on the optimal treatment for controlled ovarian stimulation for patients undergoing IVF which leads to highly variable clinical practices.What the results of this study add? This study\'s strong point is that, since it is a consensus, it has been possible to include more topics than would normally be dealt with in a systematic review or guidelines, which are generally based on a strict method that restricts the scope of the research. Experts have reached a consensus on most of the statements and based on these they have issued consensus statements that will enable the optimal use of gonadotropins in IVF.What the implications are of these findings for clinical practice and/or further research? This Delphi consensus provides a real-life clinical perspective on gonadotropin usage in IVF.
摘要:
在西班牙进行了两轮Delphi研究。列出了三个基于主题的模块:1)患者概况:根据POSEIDON患者概况分析的治疗目标和参数;2)拮抗剂的卵巢刺激方案:单一疗法(FSH)与联合疗法(FSHLH/HMG);3)设备的安全性和有效性。窦卵泡计数和抗苗勒管激素水平被认为是可用于预测卵巢反应的指标。超过80%的参与者同意FSH单一疗法是<35岁的正常/高反应患者的推荐方案;150-300IU是根据临床参数在单一疗法中用于卵巢刺激的剂量;与两种联合药物相比,FSH单一疗法可改善患者的舒适度。一致认为患者使用的设备类型会影响治疗的舒适度。目前对于接受IVF的患者的控制性卵巢刺激的最佳治疗尚无共识,这导致了高度可变的临床实践。这项研究的结果补充了什么?这项研究的优点是,既然是共识,有可能包括比通常在系统审查或准则中处理的主题更多的主题,这通常是基于限制研究范围的严格方法。专家们对大多数声明达成了共识,并在此基础上发表了共识声明,这将使促性腺激素在IVF中的最佳使用成为可能。这些发现对临床实践和/或进一步研究有什么意义?本德尔菲共识为IVF中促性腺激素的使用提供了现实生活中的临床观点。