Cessation of gonadotropin-releasing hormone analogue (GnRH-a) upon down-regulation versus conventional long GnRH-a protocol in poor responders undergoing in vitro fertilization.
OBJECTIVE
To determine whether a controlled ovarian hyperstimulation (COH) regimen that involves GnRH agonist (GnRH-a) discontinuation before administration of gonadotropins would benefit poor responders.


METHODS
A prospective, randomized controlled trial.


METHODS
Hospital-based IVF Unit.


METHODS
Sixty-three patients with previous poor response to COH and/or high basal FSH level (> or =9 mIU/mL) undergoing 78 IVF-ET cycles.


METHODS
In both groups, administration of GnRH-a was started in the midluteal phase. Whereas in the study group (40 cycles), it ended before administration of gonadotropins, in controls (38 cycles) GnRH-a treatment was continued throughout the follicular phase.


METHODS
Ovarian stimulation patterns and IVF outcome.


RESULTS
A significantly higher cancellation rate was noted in the study group than in the controls (22.5% versus 5%, respectively). The new and control regimens resulted in similar stimulation characteristics and clinical pregnancy rates (11% versus 10.3%, respectively). In 13 patients with a basal FSH level that was not persistently high, the new regimen resulted in a significantly higher number of retrieved oocytes compared with the standard protocol (7.6+/-1.03 versus 4.0+/-0.68, respectively).


CONCLUSIONS
Whereas for most low responders, the new COH regimen offers no further advantage, future prospective studies may demonstrate whether it can confer a benefit for a subset of patients with a basal FSH level that is not persistently high.
Dirnfeld
M
M
Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center and the Technion School of Medicine, Haifa, Israel.
Fruchter
O
O
Yshai
D
D
Lissak
A
A
Ahdut
A
A
Abramovici
H
H
D000328:Adult; D002064:Buserelin / Q000008:administration & dosage*; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D008297:Male; D010062:Ovulation Induction; D011247:Pregnancy; D011446:Prospective Studies; D017329:Triptorelin Pamoate / Q000008:administration & dosage*
D017329:Triptorelin Pamoate; D004958:Estradiol; D005640:Follicle Stimulating Hormone; D002064:Buserelin