Improved controlled ovarian hyperstimulation in poor responder in vitro fertilization patients with a microdose follicle-stimulating hormone flare, growth hormone protocol.
OBJECTIVE
To assess the efficacy of a novel protocol-microdose GnRH agonist (GnRH-a), FSH, and GH, for the stimulation of IVF patients who were canceled previously on a standard luteal GnRH-a, FSH, GH protocol.


METHODS
Prospective evaluation using the patient's previous IVF stimulation attempt as historic controls.


METHODS
Private practice assisted reproductive technology center.


METHODS
Thirty-two patients who had prior ovulation induction cycles canceled using luteal phase GnRH-a suppression followed by exogenous gonadotropins and GH.


METHODS
Precycle treatment with oral contraceptives followed by follicular phase administration of 40 micrograms leuprolide acetate every 12 hours beginning on cycle day 3 and FSH supplemented with GH beginning on cycle day 5.


METHODS
Paired analysis of E2 day 5, number of follicles, ampules of FSH required, and cancellation rate. The number of oocytes, embryos, embryo quality, implantation rate, and pregnancy rate (PR) were determined for completed cycles on the microdose GnRH-a, FSH, GH protocol.


RESULTS
Controlled ovarian hyperstimulation was superior during microdose GnRH-a, FSH, GH stimulation when compared with the prior luteal GnRH-a cycle. Specifically, there was a higher E2 response, more oocytes, fewer cycle cancellations, and no premature LH surge or luteinization. The microdose GnRH-a, FSH, GH protocol produced an average of 10 oocytes and a 50% ongoing PR.


CONCLUSIONS
The microdose GnRH-a, FSH, GH protocol is superior to standard protocols for the treatment of patients with decreased ovarian reserve undergoing controlled ovarian hyperstimulation for IVF.
Schoolcraft
W
W
Center for Reproductive Medicine, Englewood, Colorado 80110, USA.
Schlenker
T
T
Gee
M
M
Stevens
J
J
Wagley
L
L
D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D013006:Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage*; D016471:Ovarian Hyperstimulation Syndrome / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies
D005640:Follicle Stimulating Hormone; D013006:Growth Hormone; D016729:Leuprolide