title: Comparison of a blocking vs. a flare-up protocol in poor responders with a normal and abnormal clomiphene citrate challenge test.
abstract: This study aimed to standardize the clomiphene citrate test (CC-t) in our laboratory while comparing two different protocols of controlled ovarian stimulation in poor responders. One hundred and forty-four patients scheduled for assisted reproductive techniques were submitted to the CC-t within 3 months before starting stimulation; 133 underwent controlled ovarian stimulation with a blocking protocol. Poor responders in the first cycle (n = 30) were subsequently treated with a flare-up protocol. Although it was not statistically significant, more patients reached oocyte retrieval with the flare-up protocol. In the completed cycles, more gonadotropin ampules (55 +/- 15 vs. 34 +/- 13; p < 0.001) and more stimulation days (12.6 +/- 1 vs. 11.6 +/- 1.2; p < 0.005) were needed in the blocking than in the flare-up protocol. No difference was observed in peak 17 beta-estradiol levels, preovulatory follicles, oocytes retrieved or pregnancy rate between the two protocols. According to the threshold values, established on CC-t of patients who obtained a clinical pregnancy (n = 44), the incidence of abnormal results was 10%. All but one patient with abnormal CC-t were poor responders during the first stimulation cycle. The flare-up protocol did not improve the ovarian response in these patients.
authors.affiliation: Servizio di Fisiopatologia della Riproduzione Umana, Università di Genova, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Anserini
authors.forename: A
authors.initials: A
authors.lastname: Magnasco
authors.forename: V
authors.initials: V
authors.lastname: Remorgida
authors.forename: G
authors.initials: G
authors.lastname: Gaggero
authors.forename: D
authors.initials: D
authors.lastname: Testa
authors.forename: G L
authors.initials: GL
authors.lastname: Capitanio
mesh_terms: D000328:Adult; D002064:Buserelin / Q000008:administration & dosage; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D002996:Clomiphene / Q000627:therapeutic use; D017135:Desogestrel / Q000008:administration & dosage; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D004997:Ethinyl Estradiol / Q000008:administration & dosage; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000627:therapeutic use; D015181:Gamete Intrafallopian Transfer; D006801:Humans; D007246:Infertility / Q000628:therapy; D008596:Menotropins / Q000627:therapeutic use; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D017329:Triptorelin Pamoate / Q000627:therapeutic use
chemical_list: D006063:Chorionic Gonadotropin; D017329:Triptorelin Pamoate; D002996:Clomiphene; D004997:Ethinyl Estradiol; D004958:Estradiol; D008596:Menotropins; D017135:Desogestrel; D005640:Follicle Stimulating Hormone; D002064:Buserelin