Las gonadotropinas son intercambiables?

www.quiron.es
[1]
R1IT8GHQPC05 Rev.2 6

Enrique Prez de la Blanca. Hospital Quirn Mlaga Hospital Quirn Campo de Gibraltar

Intercambiables? hacen lo mismo?

www.quiron.es

La expresin gnica de las clulas de la granulosa es diferente tras la estimulacin con FSHr o con HMG

[2]
R1IT8GHQPC05 Rev.2 6

Brannian RB&E, 2010 Gatta, F&S, 2013

Intercambiables? hacen lo mismo?

www.quiron.es

Intercambiables? hacen lo mismo?

www.quiron.es

Intercambiables? hacen lo mismo?

FSHr > ovocitos hPHMG > MII/ovocito

www.quiron.es

MII =

INTERCAMBIABLESDURANTE EL CICLO?

FSHr vs. FSHu-FSHr

FSHr es mucho menos acdica, ms potente in vitro pero menor vida media y mayor aclaramiento.
www.quiron.es
[6]
R1IT8GHQPC05 Rev.2 6

Grupo estudio: > MII > Emb A > CPR (43,9 vs 22,1 %) > IR (27,5 vs 13 %)

Pacchiarotti, 2007, JARG.

n = 119

7 da.

Intercambiables desde el punto de vista de:

Resultados
www.quiron.es

Costes

Riesgos
[7]
R1IT8GHQPC05 Rev.2 6

Resultados

Inseminacin
www.quiron.es

FIV / ICSI
Agonistas antagonistas- baja respuesta - SOP

SET CC
[8]
R1IT8GHQPC05 Rev.2 6

Resultados en inseminacin
Table I . Patients characteristics Parameter Mean age (years) Mean duration of infertility (years) Mean BMI (kg/m2) Number of patients with BMI 25 Number of patients with BMI <25 Group I (rFSH) 30.4 2.88 3.3 1.00 25.2 1.88 41 40 Group II (uFSH) 31.5 3.64 2.9 0.87 25.2 1.88 40 40 Group III (hMG) 30.8 3.23 3.2 1.03 24.9 1.48 40 40 P NS NS NS NS NS

rol and T.Gurgan

ials and methods

undred and forty-one patients with unexplained infertility were d in this study. Patients were recruited between May 2000 and 04 and included in the study if they satisfied the following critehistory of primary infertility of >2 years, (ii) womans age n 20 and 40 years, (iii) documentation of normal ovulatory cycles, ent tubes have been shown by hysterosalpingography (HSG) or copy (L/S) and (v) normal sperm count and motility according to rld Health Organization criteria (World Health Organization, nd normal morphology according to the Krugers criteria (Kruger 988). Exclusion criteria are as follows: (i) previous assisted reprotechnology (ART) cycle, (ii) previous controlled ovarian stimuCOS)-IUI cycle and (iii) history of pelvic surgery. primary outcome measure was clinical pregnancy rate. The hypothhat rFSH results in a different clinical pregnancy rate IUI cycles for ined infertility than that in highly purified uFSH or hMG. study was designed to have sufficient power to detect an absoference (rFSH) of 15% in the clinical pregnancy rate. The pregnancy rate of 10% with IUI + COS was expected for one our centre in 2002 (unpublished data). Therefore, P1 was estias 0.25. The value of P2 was chosen to be 0.10. It was calcuat 80 patients in each group would be an adequate number to a 71.63% power of detection of differences at a significance lpha) of 0.05, using a two-sided Z-test. hundred and forty-one couples prospectively randomized into oups: Group I (Gonal-F, Serono, Turkey), 81 in the Follitropin a; II (Metrodin-HP, Serono), 80 in the highly-purified uFSH and II (Pergonal, Serono), 80 in the hMG (see Figure 1). Women were 2 d randomly to Group I, Group II or Group III on the day b of the 3rd day of menstruation with sealed envelopes by specialist nurse. ian cycle stimulation was started on the 2nd or b3rd day of uation after the basal transvaginal ultrasound (TV-USG) with

Demirol, 2007

Different gonadotrophin preparations in intrauterine insemination c

www.quiron.es

NS, non-significant; rFSH, recombinant FSH; uFSH, urinary FSH. P > 0.05.

Table II. Cycle characteristics in the groups 150 IU if the patients BMI was 25 kg/m2 with daily injections. Parameter Group I (rFSH, n + 81) 8.3 1.72 825 174.12 2.1 1.23 644 123.18 25.9 (21) 10.0 (2) 10.0 (2) 0.0 (0)

75 IU of gonadotrophins if the patients BMI was <25 kg/m2 and with

Duration of therapy (days) Total dose per cycle (IU) Number of dominant follicle E level on the day of HCG (pg/ml) Clinical pregnancy rate (%) Multiple pregnancy (%) Miscarriage rate (%) OHSS rate (%)

[9]
R1IT8GHQPC05 Rev.2 6

E , estradiol; NS, non-significant; OHSS, ovarian hyperstimulation syndrome; rFSH, recombinant FSH; uFSH, urinary FSH. NS >0.05.

Stimulation of the cycles was monitored by serum estradiol (E2) level and transvaginal sonography, and gonadotrophin doses were adjusted individually. hCG, 10 000 IU (Profasi, Serono), was given on the day which one or more follicles of 16 mm diameter. Patients with decreasing E2 levels or more than three follicles of 16 mm, on the day of HCG, the cycle was cancelled. A single insemination per cycle was performed at 36 h a after HCG administration. Sperm preparation was performed with PureSperm (Dogan Medikal, Istanbul, Turkey). A a prepared sperm volume of 0.30.4 ml was used for insemination. There were no significant a differences in semen characteristics of three groups. Only one cycle per patient was performed. a obtained 14 days after hCG administration for Serum samples were progesterone and bhCG levels. Clinical pregnancy was documented by TV-US, 6 weeks after the IUI. All groups were comparable (Table I) with regard to the age and b duration of infertility, and all patients had primary infertility. There b was no difference according to the mean BMI and number of patients Assessed for with BMI <25 kg/m2 and 25 kg/m2 among the groups. eligibility (n=284) Statistical analysis was performed by the Yates corrected chisquare, Students t-test, one-way analysis of variance (ANOVA) and Excluded (n=43) 2 ENRIQUE PREZ DE LA BLANCA HOSPITAL QUIRN MALAGA Not meeting Fishers exact tests with SPSS software, version 10.0 for windows. inclusion Statistical significance was set at P < 0.05. criteria (n=24) Refused to Institutional review board approval was obtained for prospective ran-

Group II (uFSH, n = 80) 8.8 1.51 1107 178.07 1.3 0.80 395 94.35 13.8 (11) 0.0 (0) 18.0 (2) 0.0 (0)

Group III (hMG, n = 80) 8.7 1.34 1197 211.69 1.4 0.90 455 77.36 12.5 (10) 9.0 (1) 10.0 (1) 0.0 (0)

P 0.07 0.001 0.001 0.001 0.046 0.5 0.7 NS

Downloaded from http://humrep.oxfordjournals.org/ by guest on Januar

Sagnella, 2011

R1IT8GHQPC05 Rev.2 6

ENRIQUE PREZ DE LA BLANCA HOSPITAL QUIRN MALAGA

[ 10 ]

www.quiron.es

Resultados en inseminacin

Resultados en inseminacin

[ 11 ]
R1IT8GHQPC05 Rev.2 6

www.quiron.es

Matorras y cols . F & S 2011.

Resultados en inseminacin o IO
H uman Re pro duc tio n Vo l.21, No .7 pp. 17981804, 2006 Advance Access publication March 29, 2006. doi:10.1093/humrep/del085

S imilar o vulatio n rate s , but diffe re nt fo llic ular de ve lo pme nt with hig hly purifie d me no tro phin c o mpare d with re c o mbinant FS H in WHO Gro up I I ano vulato ry infe rtility: a rando mize dc o ntro lle ds tudy
Pe te r Platte P.Platteau et al. au
1,5 , Ande rs Nybo e Ande rs e n2, Adam Bale n3, Paul De vr o e y1, Pe r S r e ns e n4, 4 L is be th H e lmgaar d4 and Joan-Car le s Ar c e fo r the M e no pur Ovulatio n I nduc tio n (M OI ) S tudy Gr oup
1

www.quiron.es

3 Table I . Demographics and baseline Department characteristics of subjects in the study Denmark, Leeds General Infirmary, of Obstetrics & Gynaecology,

Center for Reproductive Medicine of the Vrije Universiteit Brussel, Brussels, Belgium, 2Rigshospitalet, Fertility Clinic, Copenhagen, Leeds, UK and 4Ferring Pharmaceuticals A/S, Obstetrics & Gynaecology, Clinical Research & Development, Copenhagen, Denmark

5 Characteristic To whom correspondence

HP-HMG (n = 91) rFSH (n = 93) should be addressed: Center for Reproductive Medicine of the Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium. E-mail: peter.platteau@az.vub.ac.be

[ 12 ]
R1IT8GHQPC05 Rev.2 6

Age (years) 29.0 4.2 29.2 3.8 BACKGROUND: The c o ntributio n o f the LH ac tivity in me no tro phin pre paratio ns for o vulatio n induc tio n has Body weight (kg) 73.0 d 16.0 12.5 ns bee n inves tig ated in s mall tr ials c onducte ver s us FS H68.9 pre paratio . The o bj e c tive o f this s tudy was to de mo ns trate 2 BMI (kg/m ) 26.5 5.2 25.0 4.2 non-inferiority of highly pur ifie d ur inary me no tro phin (H P-H M G) ve rs us re c o mbinant FS H (rFS H) with re s pe c t to the pr imar outc ome ure , o vulation rate . M ET HODS : T his was a rando mized, o pe n-labe l, as s e s s o r-blind, mulSubjects with y BMI, n (%) meas tinational tudy. W ome n with anovulato r y infe r tility W H O Gro is tant to c lo miphene c itrate we re rand<25 kg/m2 s 42 (46.2) 54 (58.1) up I I and res o mized (c o mpute r -g e ner d lis t) to s timulatio n with HP-H M G (n = 91) or r FSH (n = 93) us ing a low-do s es tep-up 2 2 ate 25 kg/m and < 30 kg/m 19 (20.9) 25 (26.9) pr o to c ol. RESUL T S: T he o vulatio n r ate was 85.7% with HP-H M G and 85.5% with rFS H (pe r-pro to c o l po pula2 30 kg/m 30 (33.0) 14 (15.1) tion), and non-infer io r ity was demons tr ate d. Signific antly fewe r inte r me diate-s ize d follic le s we r e obs e r ved in the HP-H M G g ro up (P < 0.05). T he s ingleton live bir th r ate co mparable be twe e n the two g ro ups . The fre que nc y o f Subjects with primary infertility, 52 (57.1) 60 was (64.5) varian hypers timulatio n s yndro me and/o r c ance llatio n due to e xc es s ive res po ns e was 2.2% with HP-H M G and no (%) 9.8% with r FS H (P = 0.058). CONCL USI ONS : Stimulatio n with H P-H M G is as s oc iated with ovulatio n r ates at leas t Duration of infertility 2.9 1.8 3.0 2.1 as g ood as a r FS H (years) in anovulatory W H O Group I I wome n. LH ac tivity mo difie s fo llic ular de velo pment s o that fe we r Previous cycles ofize ovulation induction 4.6 c 2.5 4.9 2.5 inte rme diate -s d fo llic le s deve lo p. T his o uld have a po s itive impac t o n the s afe ty o f o vulation inductio n proto cols . (all) Ke y words: anovulation/highly purified menotrophin/ovulation induction/polycystic ovary syndrome/recombinant FSH Previous cycles of ovulation induction 3.9 2.5 4.1 2.5 (with clomiphene citrate) Clomiphene citrate non-responders, I ntroduc tio n could facilitate selective follicular growth, decrease the number of intermediate-sized follicles and increase the propordevelopment and subsequent mono-ovulation n Monofollicular (%) tion of women who develop one mature follicle. The LH activand singleton pregnancy are the aims of ovulation induction Failure to ovulate on clomiphene 49 (53.8) 35 (37.6) ity in menotrophin preparations could be used to promote therapy. a FSH alone is sufficient to stimulate follicular developcitrate mono-ovulation in ovulation induction protocols. This could ment, even in women with hypogonadotrophic hypogonadism lead to a reduction in the risk of ovarian hyperstimulation synFailure to conceive on Balasch clomiphene 42 (46.2) 58 (62.4) (Shoham e t al ., 1993; e t al ., 1995), although in these drome (OHSS) and multiple pregnancies and its associated patients Figure 2. Distribution of follicles at the end of s citrateb LH activity is required for adequate steroidogenesis, complications. There have been some controversies regarding fertilization and implantation (Shoham e t al ., 1991; Balasch Menstrual status, n (%) mean standard of in the mean;with NS,polynon-signi the use of preparations with LH error activity women e t al ., 1995). It has been hypothesized that LH activity may be cystic ovary syndrome (PCOS), since these women generally have Amenorrhoea 19cycles (20.9)in anovulatory 19 (20.4) of clinical relevance in ovulation induction elevated LH levels. There is, however, extensive clinical docuwomen as it could promote monofollicular 48 development (Loumaye Oligomenorrhoea (52.7) 48 (51.6) mentation with menotrophins, supporting its use in clomiphene e t al ., 2003). Exposure to LH activity during the follicular phase Anovulatory cycles (2135 days) 24 (26.4) 26 (28.0) 3 Mean volume (cm ) hed by Oxfor d Unive 8.5r 4.4 8.2 4.2 an Society of 1798ovarian The Author 2006. Publis s ity Pre s s on behalf of the Europe Human R e production and Embr yology. All r ights res erve d. not significantly different (Table III). There ENRIQUE PREZ DE LA BLANCA For Permi s sifollicles ons , please em ai l: j ournals .pe rmis si ons @oxfordjour nals .org 15.3 Number of antral >2 mm 25.1 18.0 23.0 HOSPITAL QUIRN MALAGA The onl i ne vers i on of thi s ar ti cl e has be e n publis he d under an ope n acce s s m ode l. Use rs are e ntitle d to us e, re produce , dis s e m i nate , or dis play the ope n

Aleatorizado n = 184

Tasas de ovulacin similares

Nmero de folculos intermedios

Seguridad

acces s ve rs ion of this article for non-com me rcial purpos e s provide d that: the or i ginal authors hi p i s pr operl y and full y attr ibuted; the Journal and Oxford

in endometrial thickness at the end of sti

Resultados en inseminacin
Los resultados en tasa de embarazo clnico son mejores para FSHr que para FSHu.
www.quiron.es

No hay diferencias demostradas entre FSHr y HMGhp.

Para una misma respuesta la cantidad de FSH necesaria es menor cuando cuando se utiliza FSHr .
[ 13 ]
R1IT8GHQPC05 Rev.2 6

Resultados en FIV / ICSI

www.quiron.es

Al Inany,2008
[ 14 ]
R1IT8GHQPC05 Rev.2 6

Coomarasamy, 2008

HMG vs FSHr

Resultados en FIV / ICSI

MERIT + EISG = 986
www.quiron.es

PROTOCOLO LARGO NO ICSI FRESCO LBR POR CICLO Y POR TRANSFERENCIA: Mejor HP-hMG OR 1,36 PERO: MS DAS MS DOSIS IGUAL TASA DE IMPLANTACIN ONGOING

[ 15 ]
R1IT8GHQPC05 Rev.2 6

Platteau, 2008. RBM Online.

Resultados en FIV / ICSI

www.quiron.es

Conclusin: usar la menos cara

[ 16 ]
R1IT8GHQPC05 Rev.2 6

van Wely, 2011, 42 ensayos, 9606 parejas..

Resultados en FIV / ICSI

www.quiron.es

HMG y HP-hMG estn en el mismo grupo

Se compara FSHr con Urinarias incluyendo FSHu No incluye an FSHr-CFT

[ 17 ]
R1IT8GHQPC05 Rev.2 6

van Wely, 2011, 42 ensayos, 9606 parejas..

Resultados en FIV / ICSI

Urinaria
FSHr
SERONO

ORGANON
www.quiron.es

FERRING IBSA

NINGUNO
TODOS

[ 18 ]
R1IT8GHQPC05 Rev.2 6

van Wely, 2011, 42 ensayos, 9606 parejas..

Resultados en FIV / ICSI

www.quiron.es

FSH vs FSH-CTP no hay diferencia con dosis de > 120 mcg

Con < 120 mcg, FSH es mejor

[ 19 ]
R1IT8GHQPC05 Rev.2 6

Pouwer, 2012. 4 ensayos, 2335 parejas.

Resultados en SET
ESTUDIO MEGASET
Antagonistas / no ACO EOD/seminal leve ICSI 150 x 5

www.quiron.es

= BLASTOCISTOS = LBR en fresco = LBR acumulada en un ao

FSHr: < dosis

> folculos pequeos < estradiol > ovocitos (= MII) > embriones
[ 20 ]
R1IT8GHQPC05 Rev.2 6

Devroey y cols. F & S 2012

Resultados diversos
Evitar la HO
www.quiron.es

: no hay diferencias

(van Wely, 2011, CDSR)

Aadir la LH (o su efecto) cuando sea necesaria:

LHr: >40 aos (Mochtar, 2007, CDSR) HCG:- Al final del ciclo: ahorro en gonadotropinas e igual resultado (Filicori 2005, F&S)(Blockeel, 2009, HR) (Martins, 2013, CDSR) - Desde inicio: mejores embriones, mas ovocitos . Similar a Hp-HMG? : > 100u HCG (HpHMG 75=10 UI) (Thuesen, 2012, HR. 2014, JCEM. Drakakis, 2009, RBE)

[ 21 ]
R1IT8GHQPC05 Rev.2 6

Resultados diversos
Evitar la elevacin de la PG: mas bien dosis y tipo frenacin.

www.quiron.es

Si efecto LH/HCG desde inicio, PG no sube. Si efecto LH/HCG slo al final, PG sube.

[ 22 ]
R1IT8GHQPC05 Rev.2 6

Hughes, 2011. HR

Resultados diversos: ploida

FSH > ovocitos
www.quiron.es

HMG > Euploides

HMG = FSH

[ 23 ]
R1IT8GHQPC05 Rev.2 6

Baart 2009, RBM.

Costes

Potencia y precisin
www.quiron.es

Administracin
Presentacin

[ 24 ]
R1IT8GHQPC05 Rev.2 6

Potencia: IAC / IO (potencia o precisin??)

Table I I I . Overview of the clinical data

Clinical criteria Subjects who met the HCG criteria, n (%) Number of follicles according to size a 11 mm 1216 mm 17 mm Duration of gonadotrophin treatment (days) Total gonadotrophin dose (IU) Threshold gonadotrophin dose (IU) FSH level just prior to HCG administration (IU/l) LH level just prior to HCG administration (IU/l) HCG level just prior to HCG administration (IU/l) Estradiol level just prior to HCG administration (pmol/l) Endometrial thickness at the time of HCG administration (mm) Subjects who received HCG, n (%) Subjects who ovulated, n (%) Subjects who experienced OHSS, n (%) Subjects with a clinical pregnancy (7 2 weeks after HCG), n (%) Subjects with an ongoing pregnancy (12 2 weeks after HCG), n (%) Singleton pregnancy Multiple pregnancy Subjects with a live birth, n (%) Singleton live birth Multiple live birth Preterm birthb, n (%) Admission to neonatal intensive care unitb, n (%) Birth weight b (g)

HP-HMG (n = 91) 83 (91.2)

rFSH (n = 93) 82 (88.2)

18.1 1.04 1.12 15.3

1.80 0.25* 0.07 7.9

14.2 1.91 1.24 12.0

1.39 0.34 0.07 5.0

1491 1177 99.8 32.2 9.6 2.1* 11.6 10.9 1.08 0.36 1319 1284 9.6 2.1 82 76 1 14 (90.1) (83.5) (1.1) (15.4)

1022 580 86.4 21.0 7.6 2.6 13.5 15.7 1508 1768 9.1 2.1 84 79 3 17 (90.3) (84.9) (3.2) (18.3)

13 (14.3) 13 0 13 13 0 0 1 (14.3) (14.3) (14.3) (7.7)

16 (17.2) 14 2 16 14 2 5 3 (15.1) (2.2) (17.2) (15.1) (2.2) (27.8) (18.8)

[ 25 ]
R1IT8GHQPC05 Rev.2 6

3560 680

3174 754

HP-HMG, highly purified HMG; rFSH, recombinant FSH. Data are number

with different sp FSH bioactivity 1999) or higher follicles after sti in low-dose ovu tions of these fin acteristics betw None of the stud intermediate-size decrease in inte activity (Louma growth of all fol mediate-sized fo the granulosa c parameters, ther HMG and rFSH follicular develo more to reach th The ovulatio 80% used in the found in previo ovulation rates (Loumaye et al . litropin beta (C pregnancy rate text of the type protocol used ( policy. Pregnan line with other 17% in clomiph protocols (Hom neloglu, 2004). nancy rate may

www.quiron.es

Platteau, 2006

Potencia: IAC

Demirol, 2007

Different gonadotrophin preparations in intrauterine insemination c

Table II. Cycle characteristics in the groups

www.quiron.es

Parameter Duration of therapy (days) Total dose per cycle (IU) Number of dominant follicle E2 level on the day of HCG (pg/ml) Clinical pregnancy rate (%)b Multiple pregnancy (%)b Miscarriage rate (%)b OHSS rate (%)b

Group I (rFSH, n + 81) 8.3 1.72 825 174.12a 2.1 1.23a 644 123.18a 25.9 (21)a 10.0 (2) 10.0 (2) 0.0 (0)

Group II (uFSH, n = 80) 8.8 1.51 1107 178.07 1.3 0.80 395 94.35 13.8 (11) 0.0 (0) 18.0 (2) 0.0 (0)

Group III (hMG, n = 80) 8.7 1.34 1197 211.69 1.4 0.90 455 77.36 12.5 (10) 9.0 (1) 10.0 (1) 0.0 (0)

P 0.07 0.001 0.001 0.001 0.046 0.5 0.7 NS

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R1IT8GHQPC05 Rev.2 6

E2, estradiol; NS, non-significant; OHSS, ovarian hyperstimulation syndrome; rFSH, recombinant FSH; uFSH, urinary FSH. NS >0.05. P values are for the comparisons between the three groups. a The value causes statistical significance. b Percentages and number of cases are given in parentheses.

Potencia: IAC

Sagnella, 2011
Dosis mnima 75-150 s/BMI
www.quiron.es
[ 27 ]
R1IT8GHQPC05 Rev.2 6

Potencia: IAC

[ 28 ]
R1IT8GHQPC05 Rev.2 6

www.quiron.es
Matorras y cols . F & S 2011.

IIU: Potencia/Costes
Consenso de Capri Objetivo: 1-2 folculos
www.quiron.es

Dosis mnima eficaz Precisin (37,5-50-75 u)

Presentacion sin desperdicios/faltas

[ 29 ]
R1IT8GHQPC05 Rev.2 6

Costes en FIV/ICSI

www.quiron.es

RNV tras fresco y congelado : mejor con HP-hMG: 53,7 % vs 44,6 % (p<0,05) Coste por Recien nacido vivo: HP-hMG: 11.157 libras. FSHr: 14.227 libras. (p>0,001)

[ 30 ]
R1IT8GHQPC05 Rev.2 6

RBM online, 2010 ------ Platteau, RBM, 2008

Costes en FIV/ICSI

www.quiron.es
[ 31 ]
R1IT8GHQPC05 Rev.2 6

= RNV > Ovocitos con rFSH = RNV frescos + congelados

Fresco + Congelado: ms barato con FSHr (6,43%, 411) Solo ciclos en fresco: ms barato con FSHr (3,54%, 200)
Por recin nacido vivo: FSH: 10.282 HP-hMG: 10.994

Wex, Abou-Setta, 2013. Metaanlisis, Suecia, hpHMG vs rFSH

Costes en FIV / ICSI

FSH vs FSH/HCG-lff
www.quiron.es

5 RCT, 351 pacientes

No disminuye CPR No aumenta SHO Podra disminuir el coste Evidencia de muy mala calidad

[ 32 ]
R1IT8GHQPC05 Rev.2 6

Martins y cols, 2013.

Potencia
DONACION DE OVOCITOS

www.quiron.es

Coste menor si HMG.

Se llevan las donantes la medicacin (y la preparan)? No se cuenta lo que se tira? Coste de administracin?
[ 33 ]
R1IT8GHQPC05 Rev.2 6

Melo, 2010, F&S. 1028 donantes, RCT. LARGO

Otros factores sobre costes

Presentaciones Dosis

www.quiron.es

Preparacin
Sobrante

[ 34 ]
R1IT8GHQPC05 Rev.2 6

[ 35 ]
R1IT8GHQPC05 Rev.2 6

www.quiron.es

!Ya! Receso de 15 segundos. continuamos

Precisin: FBM
Mtodo de medicin de bioactividad Steelman-Pohley (UI)
www.quiron.es
[ 36 ]
R1IT8GHQPC05 Rev.2 6

Precisin: FBM

[ 37 ]
R1IT8GHQPC05 Rev.2 6

www.quiron.es

Riesgos
SHO
www.quiron.es

Embarazo mltiple Seguridad biolgica

[ 38 ]
R1IT8GHQPC05 Rev.2 6

Riesgos
Van Wely , 2011. CDSR

Embarazo mltiple S. H. O.

www.quiron.es

=
[ 39 ]
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Seguridad biolgica: alergia Alergia

www.quiron.es
[ 40 ]
R1IT8GHQPC05 Rev.2 6

www.quiron.es

Riesgo Infecciones (slo terico)

Fuente ilimitada de gonadotropinas

Nuevas formas de administracin (long acting, orales)
[ 41 ]
R1IT8GHQPC05 Rev.2 6

Nueva LHr o incluso HCG

Seguridad biolgica
Priones

www.quiron.es

WHO Tables on Tissue Infectivity Distribution in Transmissible Spongiform Encephalopathies Updated 2010

Tejidos baja infectividad Tejidos sin de infectividad detectable

[ 42 ]
R1IT8GHQPC05 Rev.2 6

INTERCAMBIABLES?

www.quiron.es

POR RESULTADOS !CLARO! POR COSTE, CLARO! POR SEGURIDAD?

[ 43 ]
R1IT8GHQPC05 Rev.2 6

INTERCAMBIABLES?

[ 44 ]
R1IT8GHQPC05 Rev.2 6

NO SE CONOCE NINGUNA INFECCIN O PATOLOGA TRANSMITIDA A TRAVES DE GONADOTROPINAS URINARIAS..

www.quiron.es

INTERCAMBIABLES?

[ 45 ]
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www.quiron.es

.TODAVA..

Decisiones

[ 46 ]
R1IT8GHQPC05 Rev.2 6

www.quiron.es

Registro SEF 2008

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Registro SEF 2008

www.quiron.es

36,6% 2,7 %

3,7 % 1,5 %

47%

88,5 %

www.quiron.es

HOY?

[ 49 ]
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www.quiron.es
[ 50 ]
R1IT8GHQPC05 Rev.2 6

[ 51 ]
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www.quiron.es