Day 6 estradiol level predicts cycle cancellation among poor responder patients undergoing in vitro fertilization-embryo transfer cycles using a gonadotropin-releasing hormone agonist flare regimen.
OBJECTIVE
To compare two GnRHa flare protocols among poor responders undergoing IVF-ET and to evaluate if a Day 6 estradiol level can predict outcome.


METHODS
Retrospective analyses of GnRHa flare IVF cycles among poor responders. Group A ("miniflare," N = 36) 40 microg GnRHa s.c. b.i.d. from Day 3; Group B ("standard flare," N = 24) 1 mg GnRHa on Days 2-3; 0.5 mg GnRHa from Day 4. ROC analysis was performed to find a Day 6 estradiol value that is predictive of cycle outcome.


RESULTS
With the standard flare, patients required less gonadotropins and tended to have fewer cancellations and higher pregnancy rates. A Day 6 estradiol level < or = 75 pg/mL was predictive of cycle cancellation, but not of pregnancy outcome.


CONCLUSIONS
Standard GnRHa flare offers some advantages over the miniflare. Day 6 estradiol < or = 75 pg/mL is predictive of cycle cancellation. When the estradiol level is low on Day 6 (no flare), early cancellation should be considered.
Kovacs
Peter
P
Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York 10461, USA. pkovcs@aol.com
Witt
Barry R
BR
D000328:Adult; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000031:analogs & derivatives* / Q000494:pharmacology*; D006801:Humans; D008597:Menstrual Cycle / Q000187:drug effects*
D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; C083781:LHRH, Ala(6)-Gly(10)-ethylamide-