A novel protocol of ovulation induction with delayed gonadotropin-releasing hormone antagonist administration combined with high-dose recombinant follicle-stimulating hormone and clomiphene citrate for poor responders and women over 35 years.
OBJECTIVE
To evaluate the efficacy of a novel protocol of ovulation induction for poor responders.


METHODS
Prospective, controlled, clinical study.


METHODS
Research institute's reproductive unit.


METHODS
One hundred forty-five infertile women, aged 27-39 years, candidates for assisted reproductive techniques (ART).


METHODS
Before undergoing ART, 85 patients received clomiphene citrate, high-dose recombinant human FSH, and a delayed, multidose GnRH antagonist, whereas 60 patients underwent a standard long protocol.


METHODS
Estradiol levels (pg/mL), cancellation rate, oocyte retrieval, embryo score, and fertilization and pregnancy rates.


RESULTS
Patients undergoing the study protocol obtained lower cancellation rates (4.7% vs. 34%) and higher E(2) levels (945.88 +/- 173.2 pg/mL vs. 169.55 +/- 45.07 pg/mL), oocyte retrieval (5.56 +/- 1.13 vs. 3.36 +/- 1.3), and pregnancy (22.2% vs. 15.3%) and implantation rates (13.5% vs. 7.6%) compared with those receiving the long protocol. Age negatively correlated with ovarian response in the latter, whereas the ovarian outcome results were comparable in younger (<35 yrs) and older (>35 yrs) women treated with the study protocol.


CONCLUSIONS
The proposed protocol of ovulation induction can be usefully administered in poor responders as well as in aged woman, probably because the delayed administration of GnRH antagonist prevents its adverse effects on ovarian paracrine activity and on oocyte maturation.
D'Amato
Giuseppe
G
Unità Operativa di Fisiopatologia della Riproduzione Umana, IRCCS "S. De Bellis," Castellana Grotte (Ba), Italy.
Caroppo
Ettore
E
Pasquadibisceglie
Annamaria
A
Carone
Domenico
D
Vitti
Angela
A
Vizziello
Giovanni Michele
GM
D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D010064:Embryo Implantation; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000008:administration & dosage*; D006801:Humans; D007247:Infertility, Female / Q000503:physiopathology / Q000628:therapy*; D008423:Maternal Age; D009865:Oocytes; D010053:Ovary / Q000503:physiopathology; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D018566:Pregnancy, High-Risk; D011994:Recombinant Proteins / Q000008:administration & dosage; D019233:Retreatment; D020858:Tissue and Organ Harvesting
D004338:Drug Combinations; D006727:Hormone Antagonists; D011994:Recombinant Proteins; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D005640:Follicle Stimulating Hormone