Agonist “flare-up” versus antagonist in the management of poor responders undergoing in vitro fertilization treatment

Mohamed, Kamel; Davies, William A.; Allsopp, Julian; Lashen, Hany

doi:10.1016/j.fertnstert.2004.07.963

Cited by 58 publications

(40 citation statements)

References 18 publications

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“…In this study we not only examined the level of basal FSH, but we insisted that if the basal FSH level was low, we wanted the level of estrodiol also to be low to exclude the possibility that the FSH was brought down because of a high circulating level of estradiol. Although different types of gonadotrophins and agonist or antagonist protocols were used for stimulation, this should have had no effect on the outcome of ovulation induction as there is strong evidence in the literature suggesting that different gonadotrophins and agonist or antagonist protocols ultimately have the same effect on follicular development (Agrawal et al, 2000;Borm and Mannaerts, 2000;Van Wely et al, 2003;Mohamed et al, 2005). Whether the long protocol or Cetrotide protocol was used, the FSH which was measured was the nearest to the cycle.…”

Section: Discussionmentioning

confidence: 99%

Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH

Abdalla

Thum

2005

Human Reproduction

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BACKGROUND: It is a common practice to repeatedly test the level of basal FSH early in the cycle and to start IVF treatment only when the FSH level is below a certain threshold value. This is based on the idea that these women will respond better to ovarian stimulation when the basal FSH level is lower at the start of the cycle. The aim of this study is to assess the value of this practice. The results of this study reveal that women who are poor responders or with reduced ovarian reserve have a poor outcome and repeatedly testing them will add no value. Cycling women with a history of elevated FSH should be offered treatment without further delay. Delaying treatment for these women could be counterproductive, as they may have to wait for many months, during which time they are getting older and closer to their menopause.

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Section: Discussionmentioning

confidence: 99%

Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH

Abdalla

Thum

2005

Human Reproduction

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“…Nowadays, assisted reproductive technology (ART) is so popular in treatment of infertility, but the main problem in these methods is treatment of poor responder patients [1]. The rates of poor ovarian responses to the stimulation have been reported from 9% to 24% [2,3] leading to a low pregnancy rate in these patients (about 2%-4%) [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

Aghahosseini

Aleyassin

Khodaverdi

et al. 2011

J Assist Reprod Genet

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Purpose This study was designed to evaluate the effects of adding Estradiol (E2) supplementation to progesterone (P) on improvement of pregnancy outcomes in poor responder patients who underwent in vitro fertilization (IVF).Methods In a prospective randomized clinical trial, 118 poor responder patients, older than 38 years without contraindications of estradiol consumption from Infertility clinic of a university hospital were randomly divided (by computerized software) into two groups. Control group (59 patients) received only P and intervention group (59 patients) received P and E2 (4 mg/d). Supplementation was done with 4 mg E2 in the luteal phase. Fertilization rate, implantation rate, biochemical and clinical pregnancy rates, abortion rate, ongoing pregnancy, multiple pregnancy and ectopic pregnancy rates were documented for those who completed the study protocol in each group (per protocol analysis) and compared between groups. Result Fifty five patients in control group and 53 patients in intervention group successfully completed the study protocol. Treatment outcomes were not significantly different between two groups. Conclusion For poor responder women who underwent IVF, addition of E2 to P supplementation could not significantly improve pregnancy outcomes.

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“…Other studies (Malmusi et al, 2005;Mohamed et al, 2005;Demirol and Gurgan, 2009) have shown, that the flare-up protocol is more effective than the GnRH-antagonist protocol in terms of retrieved oocytes and top-quality embryos in poor responder patients. Bodri et al (2006Bodri et al ( , 2011 used oocyte donation cycles to compare both protocols.…”

Section: Discussionmentioning

confidence: 97%

A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF

Gordts

Puttemans

Campo

et al. 2011

Fertility and Sterility

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Objective: To compare two short protocols for ovarian stimulation in IVF cycles using an antagonist and an agonist short protocol. The outcomes studied were dosis rec FSH needed, days of stimulation, number of oocytes retrieved and pregnancy outcome. Methods: A prospective randomised study design. Inclusion criteria: first or second IVF attempt in women younger than 40 years. In the agonist protocol (Suprefact ® ) nasal spray was used. In the antagonist protocol (Orgalutran) ® was started as soon as at least 1 follicle of 12 mm was visualized on ultrasound. Results: 160 cycles were included in the study: 80 in the antagonist group and 80 in the agonist group. A higher dosis of recombinant FSH (rec FSH) was used for stimulation in the antagonist group (1897 IU versus 1655 IU). Pregnancy rate per ET in the antagonist group was 37% with an ongoing pregnancy rate of 21%/ET and an implantation rate of 22%; versus respectively 39%, 20% and 22% in the agonist treated group. Live birth rate per started cylce was 19% in the antagonist group versus 20% in the agonist group. Conclusion: This study shows that implantation rates, ongoing pregnancy rates and live birth rates are equal in both groups. An identical number of oocytes was retrieved, with no difference in duration of the stimulation although a higher dosis of rec FSH was needed in the antagonist group.

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Agonist “flare-up” versus antagonist in the management of poor responders undergoing in vitro fertilization treatment

Cited by 58 publications

References 18 publications

Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH

Repeated testing of basal FSH levels has no predictive value for IVF outcome in women with elevated basal FSH

Estradiol supplementation during the luteal phase in poor responder patients undergoing in vitro fertilization: a randomized clinical trial

A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF

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