title: Comparison of a gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist flare-up regimen in poor responders undergoing ovarian stimulation.
abstract: OBJECTIVE
  To compare the efficacy of flare-up and GnRH-antagonist treatment in poor-responder patients.
  
  
  METHODS
  Randomized prospective study.
  
  
  METHODS
  Assisted reproduction center.
  
  
  METHODS
  Fifty-five poor-responder patients undergoing intracytoplasmic sperm injection (ICSI).
  
  
  METHODS
  Thirty patients received GnRH agonist on the 1st day of menstruation, followed by exogenous gonadotropins from the 2nd day. Twenty-five patients received exogenous gonadotropins starting on the second day of menstruation, followed by GnRH antagonist when the leading follicle reached 14 mm in diameter.
  
  
  METHODS
  The total dose of FSH administered during the ovarian stimulation, as well as the number of mature oocytes retrieved, embryo quality, fertilization, implantation, and pregnancy rates were evaluated.
  
  
  RESULTS
  The number of ampules and units of FSH administered were significantly less in the flare-up than in the antagonistic group. The numbers of mature oocytes retrieved and of top-quality embryos transferred were significantly greater in the flare-up than in the GnRH-antagonist group. The fertilization rate (84% vs. 63%) was significantly higher in the flare-up than in the GnRH-antagonist group. The implantation and pregnancy rate were similar in the two groups.
  
  
  CONCLUSIONS
  The flare-up protocol appears to be more effective than the GnRH-antagonist protocol in terms of mature oocytes retrieved, fertilization rate, and top-quality embryos transferred in poor-responder patients.
authors.affiliation: Institute of Obstetrics and Gynecology, Policlinico of Modena, Modena University, Modena, Italy. antlamarca@libero.it
authors.forename: Stefania
authors.initials: S
authors.lastname: Malmusi
authors.forename: Antonio
authors.initials: A
authors.lastname: La Marca
authors.forename: Simone
authors.initials: S
authors.lastname: Giulini
authors.forename: Susanna
authors.initials: S
authors.lastname: Xella
authors.forename: Daniela
authors.initials: D
authors.lastname: Tagliasacchi
authors.forename: Tiziana
authors.initials: T
authors.lastname: Marsella
authors.forename: Annibale
authors.initials: A
authors.lastname: Volpe
mesh_terms: D000328:Adult; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy; D010062:Ovulation Induction / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D017211:Treatment Failure
chemical_list: D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone