Abstract
OBJECTIVE: To determine the potential effect of the ultrashort gonadotropin-releasing hormone (GnRH) agonist/GnRH antagonist protocol versus the microdose GnRH agonist flare-up protocol in poor responders undergoing intracytoplasmic sperm injection (ICSI).DESIGN: Prospective randomized trial.MATERIALS AND METHODS: Eligible poor responder patients were randomized into two groups by computer-assisted randomization. The patients in Agonist-Antagonist Group (n=41) were administered the ultrashort GnRH-agonist/ antagonist protocol, while the patients in Microdose Group (n=41) were stimulated according to the microdose flare-up protocol. The mean number of mature oocytes (metaphase II, M2) retrieved was the primary outcome measure. Fertilization rate, implantation rate per embryo and clinical pregnancy rates were secondary outcome measures.RESULTS: Demographic characteristics of the patients were similar in both groups. The mean number of mature oocytes retrieved was not different between two groups (7.1 ± 4.9 in AAP Group; 7.4 ± 6.0 in Microdose Group; P>0.05). There were also no statistical differences between the two groups in terms of peak estradiol (E2) level, canceled cycles, endometrial thickness on human chorionic gonadotropin (HCG) day, number of 2 pronucleus (PN) and number of embryos transferred. However, the total gonadotropin consumption (3365.93 ± 1627.59 vs 2327.02 ± 929.46; p=0.004) and duration of stimulation (10.51 ± 2.4 vs 9.05 ± 2.61, respectively) were significantly higher with Agonist-Antagonist Group compared with the Microdose Group. The implantation (7.6% vs 8.6%, respectively) and clinical pregnancy rates (19.5% vs 26.3%) were similar between the two groups.CONCLUSION: Despite high dose of gonadotropin consumption and longer duration of stimulation with the ultrashort GnRH agonist/GnRH antagonist protocol, it seems that the Agonist-Antagonist Protocol is as effective as microdose flare-up protocol in poor responders undergoing assisted reproduction. OBJECTIVE: To determine the potential effect of the ultrashort gonadotropin-releasing hormone (GnRH) agonist/GnRH antagonist protocol versus the microdose GnRH agonist flare-up protocol in poor responders undergoing intracytoplasmic sperm injection (ICSI). DESIGN: Prospective randomized trial. MATERIALS AND METHODS: Eligible poor responder patients were randomized into two groups by computer-assisted randomization. The patients in Agonist-Antagonist Group (n=41) were administered the ultrashort GnRH-agonist/ antagonist protocol, while the patients in Microdose Group (n=41) were stimulated according to the microdose flare-up protocol. The mean number of mature oocytes (metaphase II, M2) retrieved was the primary outcome measure. Fertilization rate, implantation rate per embryo and clinical pregnancy rates were secondary outcome measures. RESULTS: Demographic characteristics of the patients were similar in both groups. The mean number of mature oocytes retrieved was not different between two groups (7.1 ± 4.9 in AAP Group; 7.4 ± 6.0 in Microdose Group; P>0.05). There were also no statistical differences between the two groups in terms of peak estradiol (E2) level, canceled cycles, endometrial thickness on human chorionic gonadotropin (HCG) day, number of 2 pronucleus (PN) and number of embryos transferred. However, the total gonadotropin consumption (3365.93 ± 1627.59 vs 2327.02 ± 929.46; p=0.004) and duration of stimulation (10.51 ± 2.4 vs 9.05 ± 2.61, respectively) were significantly higher with Agonist-Antagonist Group compared with the Microdose Group. The implantation (7.6% vs 8.6%, respectively) and clinical pregnancy rates (19.5% vs 26.3%) were similar between the two groups. CONCLUSION: Despite high dose of gonadotropin consumption and longer duration of stimulation with the ultrashort GnRH agonist/GnRH antagonist protocol, it seems that the Agonist-Antagonist Protocol is as effective as microdose flare-up protocol in poor responders undergoing assisted reproduction.
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