title: A comparison of three downregulation approaches for poor responders undergoing in vitro fertilization.
abstract: 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.
authors.affiliation: Division of Reproductive Endocrinology, Center for Reproductive Health, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Detti
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Williams
authors.forename: Jared C
authors.initials: JC
authors.lastname: Robins
authors.forename: Rose A
authors.initials: RA
authors.lastname: Maxwell
authors.forename: Michael A
authors.initials: MA
authors.lastname: Thomas
mesh_terms: 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
chemical_list: D007987:Gonadotropin-Releasing Hormone