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:
Participant gender:
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 .