A Comparison of Three Downregulation Approaches for Poor Responders Undergoing in Vitro Fertilization

Document Type

Article

Publication Date

11-2005

Abstract

Objective

To assess the efficacy of three different GnRH agonist (GnRH-a) stimulation regimens to improve ovarian response in poor responders undergoing IVF.

Design

Retrospective cohort study.

Setting

Center for Reproductive Health at the University of Cincinnati Medical Center.

Patient(s)

Women diagnosed as poor responders who presented consecutively from January 1999 to January 2004.

Intervention(s)

Patients underwent three different stimulation regimens during IVF cycles: [1] stop protocol: GnRH-a 500 μg/d administered from the midluteal phase to the start of menses, then gonadotropins from day 2 of cycle, [2] microdose flare: GnRH-a 20 μg administered twice daily with gonadotropins from day 2 to the day of hCG administration, or [3] regular dose flare: gonadotropins beginning with GnRH-a on day 2 at 1 mg/d for 3 days, followed by 250 μg/d until the day of hCG administration.

Main Outcome Measure(s)

Ovarian response, implantation rates, clinical pregnancy and delivery rates.

Result(s)

Sixty-one IVF cycles were included in the study. None of the comparisons reached statistical significance; however, the microdose group demonstrated a trend toward a higher completed pregnancy rate.

Conclusion(s)

The microdose flare protocol for poor responders demonstrated a trend toward higher delivery rates. A larger prospective study would need to be performed to determine whether this trend leads to a significant finding in this patient population.

Comments

Presented at the 60th Annual Meeting of the American Society for Reproductive Medicine, Philadelphia, Pennsylvania, October 16–20, 2004.

DOI

10.1016/j.fertnstert.2005.04.053

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