title: Cessation of gonadotropin-releasing hormone agonist therapy combined with high-dose gonadotropin stimulation yields favorable pregnancy results in low responders.
abstract: OBJECTIVE
  To evaluate the pregnancy results of an ovarian hyperstimulation protocol for IVF-ET that combines GnRH agonist down-regulation, cessation of GnRH agonist therapy with the onset of menstruation, and high-dose gonadotropin administration in low responders.
  
  
  METHODS
  Prospective analysis.
  
  
  METHODS
  Academic IVF program.
  
  
  METHODS
  One hundred eighty-two low responders undergoing 224 IVF-ET cycles.
  
  
  METHODS
  Down-regulation was obtained with the administration of leuprolide acetate beginning in the midluteal phase and ending with the onset of menses. Daily administration of 6 ampules of FSH alone or in combination with hMG was initiated on cycle day 3.
  
  
  METHODS
  Stimulation characteristics and pregnancy rates (PRs) were compared between fresh cycles in which pure FSH alone was used and 35 cycles in which a combination of FSH and hMG was administered.
  
  
  RESULTS
  The clinical PR per transfer, the ongoing PR per transfer, and the implantation rate were 32%, 24%, and 9%, respectively. No differences were noted between cycles in which pure FSH alone was used in comparison with cycles in which a combination of FSH and hMG was administered.
  
  
  CONCLUSIONS
  Short-term ovarian suppression begun in the luteal phase and discontinued with the onset of menses followed by high-dose stimulation with gonadotropins yields favorable pregnancy results in low responders.
authors.affiliation: Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Faber
authors.forename: J
authors.initials: J
authors.lastname: Mayer
authors.forename: B
authors.initials: B
authors.lastname: Cox
authors.forename: D
authors.initials: D
authors.lastname: Jones
authors.forename: J P
authors.initials: JP
authors.lastname: Toner
authors.forename: S
authors.initials: S
authors.lastname: Oehninger
authors.forename: S J
authors.initials: SJ
authors.lastname: Muasher
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use*; D007986:Luteinizing Hormone / Q000097:blood; D008596:Menotropins / Q000008:administration & dosage; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D008596:Menotropins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D016729:Leuprolide