Limited success using the “flare” protocol in poor responders in cycles with low basal follicle-stimulating hormone levels during in vitro fertilization

Abstract

Objective: To assess an alternate protocol for stimulating poor responders. Design: Prospective clinical study. Setting: University-affiliated infertility clinic. Patient(s): Eighty poor responders. Intervention(s): Stimulation was withheld until patients fulfilled the following criteria: basal FSH ≤ 12 mIU/mL (conversion factor to SI unit, 1.00) with concurrent E 2 level ≤ 100 pg/ mL (conversion factor to SI unit, 3.671), and P level ≤ 1.0 ng/mL (conversion factor to SI unit, 3.467). They then started leuprolide acetate on cycle day 2 and a high dose of gonadotropins on cycle day 3. Main Outcome Measure(s): Stimulation response and pregnancy rates (PRs). Result(s): Nineteen cycles (23.8%) were canceled because of poor ovarian response. The mean E 2 level on day of hCG was 2,578 ± 1,339 pg/mL (9,464 ± 4,915 pmol/L) (range, 789 to 5934 pg/mL [2,896 to 21,784 pmol/l]). The number of oocytes retrieved was 10 ± 6.6 (range, 1 to 37). Nine patients did not have ET (failed fertilization [n = 5], no cleavage of preembryos [n = 3], freeze all [n = 1]). The number of pre-embryos transferred was 3.9 ± 1.6 (range, 1 to 8). The clinical pregnancy rate was 7 of 61 (11.5%) per retrieval, and 7 of 52 (13.4%) per transfer with an implantation rate of 7 of 201 (3.5%). Three patients miscarried with an ongoing PR of 4 of 61 (6.5%) per retrieval and 4 of 52 (7.6%) per transfer. Conclusion(s): Poor responders undergoing controlled ovarian hyperstimulation with the “flare” protocol in cycles with low basal FSH will often show adequate ovarian response and reach oocyte retrieval and ET. The PRs, however, remain low.