Abstract
Objective. To compare the effectiveness of a flexible multidose gonadotropin-releasing hormone (GnRH) antagonist against the effectiveness of a microdose flare-up GnRH agonist combined with a flexible multidose GnRH antagonist protocol in poor responders to in vitro fertilization (IVF). Study Design. A retrospective study in Akdeniz University, Faculty of Medicine, Department of Obstetrics and Gynecology, IVF Center, for 131 poor responders in the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) program between January 2006 and November 2012. The groups were compared to the patients' characteristics, controlled ovarian stimulation (COH) results, and laboratory results. Results. Combination protocol was applied to 46 patients (group 1), and a single protocol was applied to 85 patients (group 2). In group 1, the duration of the treatment was longer and the dose of FSH was higher. The cycle cancellation rate was significantly higher in group 2 (26.1% versus 38.8%). A significant difference was not observed with respect to the number and quality of oocytes and embryos or to the number of embryos transferred. There were no statistically significant differences in the hCG positivity (9.5% versus 9.4%) or the clinical pregnancy rates (7.1% versus 10.6%). Conclusion. The combination protocol does not provide additional efficacy.
Highlights
The treatment success of in vitro fertilization (IVF) is based on various factors, including the number of retrieved oocytes [1]
Patients with poor ovarian response (POR) who underwent controlled ovarian hyperstimulation (COH) with a flexible multidose gonadotropin-releasing hormone (GnRH) antagonist protocol or with a flexible multidose GnRH antagonist in combination with the microdose flare-up GnRH agonist protocol were chosen for this study
The criteria for cycle cancellation were as follows: (a) premature luteinizing hormone (LH) surge; (b) during COH, LH > 12 mIU/mL; (c) decrease in the level of E2; (d) patients who failed to respond despite stimulation for 6 days; and (e) the inability to retrieve oocytes or the underdevelopment of the embryo
Summary
The treatment success of in vitro fertilization (IVF) is based on various factors, including the number of retrieved oocytes [1]. Failure to recruit adequate follicles, from which the oocytes are retrieved, is called a “poor response.”. The incidence of poor ovarian response (POR) in controlled ovarian hyperstimulation (COH) has been reported in 9–24% of intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles [2]. To be classified with POR, a patient must exhibit two of the following: (1) being over the age of 40 (≥40 age) or any other risk factor for POR (pelvic infection, ovarian endometrioma, ovarian surgery, chemotherapy, and short menstrual cycle); (2) previous POR (with conventional stimulation protocol ≤ 3 oocytes); or (3) abnormal ovarian reserve test (the number of antral follicles < 5–7 or antiMullerian hormone (AMH) < 0.5–1.1 ng/mL) [4]
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