Prospective evaluation of two stimulation protocols for low responders who were undergoing in vitro fertilization-embryo transfer.
OBJECTIVE
To compare two stimulation protocols designed for low responders undergoing IVF.


METHODS
Randomized, prospective study.


METHODS
University hospital IVF unit.


METHODS
Sixty low responders who were recruited on the basis of results in previous cycles.


METHODS
Modified flare protocol in which a high dose of GnRH agonist was administered for the first 4 days, followed by a standard agonist dose, or a modified long protocol in which a standard agonist dose was used until pituitary down-regulation, after which the agonist dose was halved during stimulation.


METHODS
Number of oocytes retrieved.


RESULTS
Twenty-nine cycles were performed with the modified flare protocol and 31 were performed with the modified long protocol. Significantly more oocytes were obtained with the modified long protocol than the modified flare protocol (4.42 +/- 2.6 vs. 3.07 +/- 2.15). The number and quality of embryos available for transfer was similar in both groups. One clinical pregnancy (3.4%) was achieved with the modified flare protocol, and 7 pregnancies (22.5%) were achieved using the modified long protocol.


CONCLUSIONS
These preliminary results substantiate the poor prognosis and outcome for low responders undergoing IVF. A modified long "mini-dose" protocol appears to be superior to a modified mega-dose flare protocol in terms of oocyte yield and cycle outcome.
Weissman
Ariel
A
IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel. a_w@zahav.net.il
Farhi
Jacob
J
Royburt
Moshe
M
Nahum
Hana
H
Glezerman
Marek
M
Levran
David
D
D000328:Adult; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D003280:Contraceptives, Oral, Synthetic / Q000008:administration & dosage; D004624:Embryo Transfer; D019304:Ethinyl Estradiol-Norgestrel Combination / Q000008:administration & dosage; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D008186:Luteolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D009865:Oocytes / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D017329:Triptorelin Pamoate / Q000008:administration & dosage / Q000494:pharmacology*
D003271:Contraceptive Agents, Female; D003280:Contraceptives, Oral, Synthetic; D008186:Luteolytic Agents; D017329:Triptorelin Pamoate; D019304:Ethinyl Estradiol-Norgestrel Combination; D017258:Medroxyprogesterone Acetate