Failure to respond to controlled ovarian hyperstimulation (COH) is still a major concern in
assisted reproduction and there is no consensus on the ovarian stimulation choice regime for
poor responders.
Aim: To evaluate and compare the efficacy of a microdose GnRH agonist flare (MF) and a GnRH
antagonist/letrozole (A/L) protocols in poor responders undergoing in vitro fertilization
(IVF).
Methods: One hundred eighty poor responder patients will be randomized to an ovarian
stimulation protocol with either a MF or a letrozole and high dose FSH/hMG and flexible GnRH
antagonist protocol.