Comparison of agonistic flare-up-protocol and antagonistic multiple dose protocol in ovarian stimulation of poor responders: results of a prospective randomized trial

Abstract

The management of poor responders in IVF has always been a big problem. The ideal approach has yet to be formulated. In this study we aim to compare two alternative stimulation protocols. A total of 48 poor responder patients described from previous cycles were included and grouped into two: group I consisted of 24 patients in 24 cycles in which leuprolide acetate (40 microg s.c. per day) was initiated on cycle day 2 followed by exogenous gonadotrophins on cycle day 3; group II consisted of 24 patients in 24 cycles in which ovarian stimulation included gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix, 0.25 mg daily during late follicular phase) administration. While only the oestradiol concentrations on the day of HCG were lower in group II compared with group I, the clinical pregnancy and implantation rates among groups did not show any significance. The impact of these two regimens in ovarian stimulation of poor responders seem to be same and to establish these results further randomized studies with larger sample sizes are required.

Gonadotropin-Releasing Hormone (GnRH)-Antagonist Versus GnRH-Agonist in Ovarian Stimulation of Poor Responders Undergoing IVF

“…In addition, since a deleterious effect of agonists directly on the ovary might be the reason for the failure in those with a limited ovarian reserve, Akman et al compared ovarian stimulation in 20 low responders following the use of GnRH-antagonists to that without the addition of an agonist, and reported higher, though not statistically significant, clinical pregnancy and implantation rates in the antagonist group than in the group without an agonist (20 and 13.33% compared to 6.25 and 3.44%, respectively) (16). Contrary to these preliminary encouraging results, a recent prospective randomized trial comparing the efficacy of the flare-up protocol to the antagonistic multiple dose protocol in ovarian stimulation of 24 poor responders reported that of the parameters evaluated, only the estradiol concentrations on the day of hCG were higher in the GnRH-agonist group, whereas the clinical pregnancy and implantation rates among the groups did not show any significant difference, concluding that the impact of these two regimens in ovarian stimulation of poor responders seems to be the same (17).…”

A comparative study on oxidative and antioxidative markers of serum and follicular fluid in GnRH agonist and antagonist cycles

“…Other potential benefits include the lower risk of ovarian hyperstimulation syndrome [15]. However, its influence on IVF outcome and pregnancy rate, in comparison to GnRH-a protocol is controversial [16][17][18][19][20]. It is, therefore, important to understand the impact of regimes used for COH on IVF outcome as it may help physicians in predicting the chance of women becoming pregnant after IVF.…”

Anti-Mullerian hormone and antral follicle count as predictors for embryo/oocyte cryopreservation cycle outcomes in breast cancer patients stimulated with letrozole and follicle stimulating hormone

“…When ovarian response to stimulation was classified as low response (<4 mature oocytes retrieved [15]) vs. normal response, which identified 0.8-1.2 ng/mL as a potential cutoff range of serum AMH level. A significantly larger proportion of patients, 7 of 18 (38.9%) with AMH levels ≤1.2 ng/mL had low response versus none of 23 (0%) in the patients with >1.2 ng/mL, (p=0.001) (Fig.…”