GnRH flare improves pregnancy rates only in a subset of poor responders

Abstract

Objective: GnRH agonist given early in the menstrual cycle (flare) causes an endogenous discharge of FSH and LH, and has been used in conjunction with ovarian stimulation by gonadotropins for IVF patients. However, there is an ongoing controversy in the literature regarding whether the flare protocol improves pregnancy rates in poor responders. The current study was designed to assess the role of flare protocol in poor responders during IVF cycles.Design: Retrospective analysis.Materials/Methods: Seventy-three cycles using flare protocol from the beginning of 1999 to July of 2001 were retrospectively compared with previous IVF cycles in the same patients using GnRHa long-term down-regulation protocol, and with128 IVF cycles in age-matched poor ovarian responders (peak E2 less than 1000 pg/ml and/or less than five mature follicles with diameter >15 mm on the day of hCG administration) during the same time period. Student t- test was used to analyze parametrical data and Chi-squared test to compare fertilization and pregnancy rates.Results: When compared between IVF cycles using flare and down regulation protocols in the same patients, flare protocol produced higher peak E2 levels (1647 747 vs 720 258, p <0.05) and a larger number of mature follicles (5.8 2.2 vs 4.0 1.0, p <0.05). Pregnancy rates were significantly improved after using flare protocol (30% vs 0%, p <0.01). When compared between flare protocol and age-matched poor ovarian responders using down regulation protocol, the later produced lower peak E2 levels (877 312, p <0.05) and fewer mature follicles (3.8 2.2, p <0.01), but comparable pregnancy rates (36.7%, p >0.05).Conclusions: This study demonstrates that flare protocol can improve ovarian responses in poor responders, and increase pregnancy rates in poor responders who failed to conceive in IVF cycles using down regulation protocol. This study suggests that down regulation protocol may compromise treatment outcome in a subset of poor responders.Supported by: N/A. Objective: GnRH agonist given early in the menstrual cycle (flare) causes an endogenous discharge of FSH and LH, and has been used in conjunction with ovarian stimulation by gonadotropins for IVF patients. However, there is an ongoing controversy in the literature regarding whether the flare protocol improves pregnancy rates in poor responders. The current study was designed to assess the role of flare protocol in poor responders during IVF cycles. Design: Retrospective analysis. Materials/Methods: Seventy-three cycles using flare protocol from the beginning of 1999 to July of 2001 were retrospectively compared with previous IVF cycles in the same patients using GnRHa long-term down-regulation protocol, and with128 IVF cycles in age-matched poor ovarian responders (peak E2 less than 1000 pg/ml and/or less than five mature follicles with diameter >15 mm on the day of hCG administration) during the same time period. Student t- test was used to analyze parametrical data and Chi-squared test to compare fertilization and pregnancy rates. Results: When compared between IVF cycles using flare and down regulation protocols in the same patients, flare protocol produced higher peak E2 levels (1647 747 vs 720 258, p <0.05) and a larger number of mature follicles (5.8 2.2 vs 4.0 1.0, p <0.05). Pregnancy rates were significantly improved after using flare protocol (30% vs 0%, p <0.01). When compared between flare protocol and age-matched poor ovarian responders using down regulation protocol, the later produced lower peak E2 levels (877 312, p <0.05) and fewer mature follicles (3.8 2.2, p <0.01), but comparable pregnancy rates (36.7%, p >0.05). Conclusions: This study demonstrates that flare protocol can improve ovarian responses in poor responders, and increase pregnancy rates in poor responders who failed to conceive in IVF cycles using down regulation protocol. This study suggests that down regulation protocol may compromise treatment outcome in a subset of poor responders. Supported by: N/A.