title: Agonist "flare-up" versus antagonist in the management of poor responders undergoing in vitro fertilization treatment.
abstract: OBJECTIVE
  To compare the agonist flare-up and antagonist protocols in the management of poor responders to the standard long down-regulation protocol.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  Assisted conception center.
  
  
  METHODS
  One hundred thirty-four patients undergoing IVF/ intracytoplasmic sperm injection (ICSI) treatment, who responded poorly to the standard long down-regulation protocol in their first treatment cycle. In the second cycle, 77 received short flare-up agonist and 57 received antagonist protocol. We analyzed the outcome of the second cycle.
  
  
  METHODS
  Peak serum E(2) was assayed on the day of hCG administration.
  
  
  METHODS
  Cycle cancellation rate due to poor ovarian response.
  
  
  RESULTS
  There was no cycle cancellation in the flare-up protocol and 7% cancellation rate in the antagonist protocol due to lack of response. A significantly higher number of patients had embryo transfer in the flare-up protocol. There was no difference in pregnancy rate (PR) between the two groups.
  
  
  CONCLUSIONS
  Both the flare-up and the antagonist protocols significantly improved the ovarian response of known poor responders. However, a significantly higher cycle cancellation rate and less patients having embryo transfer in the antagonist group tips the balance in favor of the flare-up protocol.
authors.affiliation: CARE at the Three Shires Hospital, Northampton, UK. kamel.mohamed@ntlworld.com
authors.forename: Kamel A
authors.initials: KA
authors.lastname: Mohamed
authors.forename: W A R
authors.initials: WA
authors.lastname: Davies
authors.forename: Julian
authors.initials: J
authors.lastname: Allsopp
authors.forename: Hany
authors.initials: H
authors.lastname: Lashen
mesh_terms: D000328:Adult; D002064:Buserelin / Q000008:administration & dosage*; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000819:agonists / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000008:administration & dosage*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic
chemical_list: D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; C062876:cetrorelix; D002064:Buserelin