Combined gonadotropin releasing hormone agonist/human menopausal gonadotropin therapy (GnRH-a/hMG) in normal, high, and poor responders to hMG

Abstract

Patients who failed to conceive after gonadotropin stimulation in in vitro fertilization treatment were classified into normal, high, or poor responders. They were routinely offered another cycle with a combination of a gonadotropin releasing hormone agonist and gonadotropin therapy (in order to evaluate whether this combined therapy could improve their response). The gonadotropin-induced cycle was compared with the combined therapy cycle. With the combination treatment, in the normal responders the phase of ovarian stimulation was significantly (P less than 0.001) prolonged, and the number of follicles and oocytes collected (5.7 +/- 0.7 vs 3.1 +/- 0.4) was increased, without any change in serum estradiol level compared to the control cycle. In high responders the number of oocytes was not modified by the combined treatment compared with the control cycle. However, serum estradiol level was significantly (P less than 0.005) decreased. The combined therapy did not modify any parameter of response in poor responders. We conclude that the response to combined agonist/gonadotropin therapy is dependent on the patient's own basal response. No improvement in response was expected in poor responders.

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

“…Some studies demonstrated that adding E2 supplementation in luteal phase could not significantly affect patients' hormone profile [10], histological pattern of the endometrium [1] or estrogen receptors [3]. It seems that the optimal E2 level is not the same in different patients.…”

“…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].…”

How to improve the probability of pregnancy in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis

“…Poor response was defined as [1] at least two failed IVF cycles with <5 oocytes (14), [2] estradiol (E 2 ) <500 pg/mL on day of hCG and <3 oocytes retrieved in a previous IVF cycle (15), [3] %2 oocytes retrieved or R48 ampoules of human menopausal gonadotropins (hMG) consumed in R2 previous cycles (16), [4] <6 oocytes collected, of which <4 embryos developed in at least one previous IVF cycle (17), and [5] previous suboptimal response (not defined by the investigators) to ovarian stimulation for IVF (18).…”

Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients

“…Currently the percentage of poor responders, out of all infertile patients undergoing IVF-ET programs, is varies from 9% to 24% [2,3]. Poor responders include women in whom a previous cycle yielded three or fewer oocytes or was cancelled because of observations of three or fewer follicles 16 mm or greater, a single dominant follicle or a peak serum estradiol less than 500 pg/ml.…”