title: "Co-Flare" stimulation in the poor responder patient: predictive value of the flare response.
abstract: OBJECTIVE
  In this study we review our experience with a day 2 start, "Co-Flare" protocol analyzing the flare response as a predictor of outcome in patients with a history of a poor response.
  
  
  METHODS
  This study was conducted at a university based IVF Center. A total of 564 patient cycles over a 2.5-year time frame in patients that had either elevated FSH levels or a previous poor response to conventional leuprolide acetate down-regulated stimulation were retrospectively analyzed. These patients were treated with our co-flare protocol (1.0 mg of leuprolide acetate administered on day 2 and decreased on day 5 to 0.5 mg; gonadotropins initiated on day 3). We analyzed the initial flare response and the outcome for these patients.
  
  
  RESULTS
  A total of 564 patients attempted to initiate an IVF cycle. The patients mean age was 39.4+/-3.7 years. Of the 450 cycles that started, the outcomes were as follows: 24% (108/450) cancellation, 20.4% (92/450) clinical pregnancy per initiated cycle, and a 14.0% delivery rate per initiated cycle. Patients with an estradiol flare that doubled were less likely to have cycles cancelled (13.6% vs. 35.6%, P < 0.01), but no differences were noted in pregnancy outcome if the cycle was not cancelled once the patient made it to retrieval.
  
  
  CONCLUSIONS
  We have demonstrated an overall 14.0% delivery rate per initiated cycle in these "poor prognosis" patients. While the initial flare response (as indicated by a doubling of the estradiol by the second day of stimulation) was indicative of a better stimulation, no difference in pregnancy outcome was seen if the patient underwent retrieval.
authors.affiliation: The Center for Reproductive Medicine and Infertility, The New York Presbyterian Hospital-Cornell Medical Center, New York 10021, USA. sdspando@med.cornell.edu
authors.forename: S
authors.initials: S
authors.lastname: Spandorfer
authors.forename: J
authors.initials: J
authors.lastname: Navarro
authors.forename: L M
authors.initials: LM
authors.lastname: Kump
authors.forename: H C
authors.initials: HC
authors.lastname: Liu
authors.forename: O K
authors.initials: OK
authors.lastname: Davis
authors.forename: Z
authors.initials: Z
authors.lastname: Rosenwaks
mesh_terms: D000328:Adult; D004958:Estradiol / Q000378:metabolism*; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology*; D005307:Fertilization in Vitro / Q000379:methods; D006062:Gonadotropins / Q000494:pharmacology*; D006801:Humans; D016729:Leuprolide / Q000494:pharmacology*; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D013480:Superovulation / Q000187:drug effects* / Q000378:metabolism
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D004958:Estradiol; D016729:Leuprolide