title: Limited success using the "flare" protocol in poor responders in cycles with low basal follicle-stimulating hormone levels during in vitro fertilization.
abstract: OBJECTIVE
  To assess an alternate protocol for stimulating poor responders.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  University-affiliated infertility clinic.
  
  
  METHODS
  Eighty poor responders.
  
  
  METHODS
  Stimulation was withheld until patients fulfilled the following criteria: basal FSH < or = 12 mIU/mL (conversion factor to SI unit, 1.00) with concurrent E2 level < or = 100 pg/mL (conversion factor to SI unit, 3.671), and P level < or = 1.0 ng/mL (conversion factor to SI unit, 3.467). They then started leuprolide acetate on cycle day 2 and a high dose of gonadotropins on cycle day 3.
  
  
  METHODS
  Stimulation response and pregnancy rates (PRs).
  
  
  RESULTS
  Nineteen cycles (23.8%) were canceled because of poor ovarian response. The mean E2 level on day of hCG was 2,578 +/- 1,339 pg/mL (9,464 +/- 4,915 pmol/L) (range, 789 to 5934 pg/mL [2,896 to 21,784 pmol/L]). The number of oocytes retrieved was 10 +/- 6.6 (range, 1 to 37). Nine patients did not have ET (failed fertilization [n = 5], no cleavage of preembryos [n = 3], freeze all [n = 1]). The number of pre-embryos transferred was 3.9 +/- 1.6 (range, 1 to 8). The clinical pregnancy rate was 7 of 61 (11.5%) per retrieval, and 7 of 52 (13.4%) per transfer with an implantation rate of 7 of 201 (3.5%). Three patients miscarried with an ongoing PR of 4 of 61 (6.5%) per retrieval and 4 of 52 (7.6%) per transfer.
  
  
  CONCLUSIONS
  Poor responders undergoing controlled ovarian hyperstimulation with the "flare" protocol in cycles with low basal FSH will often show adequate ovarian response and reach oocyte retrieval and ET. The PRs, however, remain low.
authors.affiliation: Division of Reproductive Endocrinology, Center for Human Reproduction, University of Illinois, Chicago 60610, USA.
authors.forename: V
authors.initials: V
authors.lastname: Karande
authors.forename: R
authors.initials: R
authors.lastname: Morris
authors.forename: J
authors.initials: J
authors.lastname: Rinehart
authors.forename: C
authors.initials: C
authors.lastname: Miller
authors.forename: R
authors.initials: R
authors.lastname: Rao
authors.forename: N
authors.initials: N
authors.lastname: Gleicher
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D010062:Ovulation Induction; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D006063:Chorionic Gonadotropin; D004958:Estradiol; D005640:Follicle Stimulating Hormone