A comparison of three downregulation approaches for poor responders undergoing in vitro fertilization.
OBJECTIVE
To assess the efficacy of three different GnRH agonist (GnRH-a) stimulation regimens to improve ovarian response in poor responders undergoing IVF.


METHODS
Retrospective cohort study.


METHODS
Center for Reproductive Health at the University of Cincinnati Medical Center.


METHODS
Women diagnosed as poor responders who presented consecutively from January 1999 to January 2004.


METHODS
Patients underwent three different stimulation regimens during IVF cycles: [1] stop protocol: GnRH-a 500 microg/d administered from the midluteal phase to the start of menses, then gonadotropins from day 2 of cycle, [2] microdose flare: GnRH-a 20 microg administered twice daily with gonadotropins from day 2 to the day of hCG administration, or [3] regular dose flare: gonadotropins beginning with GnRH-a on day 2 at 1 mg/d for 3 days, followed by 250 microg/d until the day of hCG administration.


METHODS
Ovarian response, implantation rates, clinical pregnancy and delivery rates.


RESULTS
Sixty-one IVF cycles were included in the study. None of the comparisons reached statistical significance; however, the microdose group demonstrated a trend toward a higher completed pregnancy rate.


CONCLUSIONS
The microdose flare protocol for poor responders demonstrated a trend toward higher delivery rates. A larger prospective study would need to be performed to determine whether this trend leads to a significant finding in this patient population.
Detti
Laura
L
Division of Reproductive Endocrinology, Center for Reproductive Health, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
Williams
Daniel B
DB
Robins
Jared C
JC
Maxwell
Rose A
RA
Thomas
Michael A
MA
D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015536:Down-Regulation / Q000187:drug effects* / Q000502:physiology; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000706:statistics & numerical data; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000819:agonists*; D006801:Humans; D012189:Retrospective Studies; D017211:Treatment Failure
D007987:Gonadotropin-Releasing Hormone