Overview

Mild Stimulation Protocol Versus Microdose Gonadotropin-releasing Hormone Agonist Flare up Protocol in Poor Responders

Status:
Completed
Trial end date:
2010-05-01
Target enrollment:
0
Participant gender:
Female
Summary
Despite the progression in assisted reproductive technology (ART), the preferred protocol for poor responders is still controversial. The management of poor responders consists of 10% of ART cycles . The response to controlled ovarian hyperstimulation (COH) is lower regarding estradiol level , number of obtained oocytes , and fertilization , implantation and pregnancy rates in patients with low ovarian reserve . Furthermore , bad quality embryos are observed in these women more than normoresponders and the increase of cancellation rate and doses of gonadotropin administration are remarkable results in poor responders . Several criteria have introduced for poor responders , the main defect in the management of them is lack of specific definition .Several strategies are available to improve ART cycles outcome in poor responders. These modalities include using : high FSH dose , stop GnRH-agonist protocol , addition of growth hormone , transdermal testosterone , aromatase inhibitor , GnRH-antagonist and recombinant FSH ( r-FSH) ; while the improvement of pregnancy rate has been quite low. The most common used protocol for ovarian stimulation is microdose GnRH-agonist flare in poor responders .Some investigators concluded that the use of GnRH-agonist " even in lower doses , led to prolonged stimulation and increased the cost without improving IVF outcome. Furthermore this method increased LH , progesterone and androgen of serum in follicular phase , which caused deleterious effect on follicular growth and oocyte quality . Clomiphene citrate co-treatment with gonadotropin and antagonist are one of the recommended protocol in poor responders . Clomiphene citrate increases endogenous FSH versus agonist in microdose protocol. Decreasing the doses of used gonadotropin and duration of stimulation are its beneficial effects in COH cycle . The aim of this study was comparing CC/gonadotropin/antagonist and GnRH agonist flare protocols on IVF outcome in poor responders .
Phase:
Phase 4
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Yazd Medical University
Collaborator:
Yazd Research & Clinical Center for Infertility
Treatments:
Buserelin
Citric Acid
Clomiphene
Enclomiphene
Zuclomiphene
Criteria
Inclusion Criteria:

- Women with ≥38 years old

- women who had one or more previous failed IVF cycles in which three or fewer oocyte
were been retrieved and/or serum E2 level on the day of hCG administration was ≤500
pg/ml were enrolled in this study

Exclusion Criteria:

- BMI > 30

- endocrine disorders

- metabolic disorders

- history of ovarian surgery

- sever endometriosis

- sever male factor ( azospermia )