title: Gonadotropin-releasing hormone agonist/antagonist conversion with estrogen priming in low responders with prior in vitro fertilization failure.
abstract: OBJECTIVE
  To evaluate gonadotropin-releasing hormone (GnRH) agonist/antagonist conversion with estrogen priming (AACEP) in low responders with prior IVF failure.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  Private practice.
  
  
  METHODS
  Women aged <or=42 with prior IVF attempts in which all embryos were <7 cells or >20% fragmentation on day 3 (n = 137; <38: n = 63; 38-42: n = 74). In addition to unexplained poor response to stimulation (n = 52), diagnoses included elevated follicle-stimulating hormone (FSH >9.0 mIU/mL; n = 40), advanced age (>41 years; n = 26), endometriosis (III-IV; n = 12), and decreased ovarian reserve (AFC <5; n = 7).
  
  
  METHODS
  Patients received sequential GnRH agonist, low-dose GnRH antagonist, and estradiol valerate followed by recombinant FSH, 600 IU/day (n = 72) or 750 IU/day (n = 65).
  
  
  METHODS
  Pregnancy, ongoing gestation, implantation rates.
  
  
  RESULTS
  Although women aged <38 years and those on 600 IU/day produced more mature eggs and fertilized embryos than women aged 38 to 42 years, there were no differences in peak estradiol, endometrial lining, or embryos transferred. Outcomes were similar for all patients regardless of age or FSH dosage. Ongoing gestation rates were 27% (37 out of 137) for all patients, 25% (16 out of 63) for age <38 years, and 28% (21 out of 74) for ages 38 to 42 years.
  
  
  CONCLUSIONS
  Women aged <or=42 years who are candidates for oocyte donation may still achieve pregnancy using their own eggs with the AACEP protocol.
authors.affiliation: Sher Institute for Reproductive Medicine, Las Vegas, Nevada 89109, USA. jfisch@sherinstitute.com
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fisch
authors.forename: Levent
authors.initials: L
authors.lastname: Keskintepe
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Sher
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance / Q000187:drug effects; D046149:Embryo Culture Techniques; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D011292:Premedication; D017211:Treatment Failure; D028761:Withholding Treatment
chemical_list: D004967:Estrogens; D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone