title: Microdose follicular flare: a viable alternative for normal-responding patients undergoing in vitro fertilization?
abstract: OBJECTIVE
  To compare cycle outcomes among normal-responding patients <or=30 years old receiving microdose follicular flare (MDF) and long-luteal agonist (LL).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Military-based assisted reproductive technology (ART) center.
  
  
  METHODS
  First autologous ART cycles among 499 women <or=30 years old from January 1999 to December 2005.
  
  
  METHODS
  After oral contraceptive pill (OCP) administration before cycle start, patients were nonrandomly assigned to either LL or MDF for LH surge suppression. Patients in the LL group received 1 mg/day leuprolide acetate (LA) on cycle day 21, which was reduced to 0.25 mg/day 10-14 days later. Patients in the MDF group received LA (40 microg twice a day) beginning 3 days after discontinuing OCPs. Both groups received a combination of hMG and recombinant FSH.
  
  
  METHODS
  Primary outcomes were implantation, clinical pregnancy, and live-birth rates; in-cycle variables included peak E(2), oocytes retrieved, oocyte maturity, and fertilization rate.
  
  
  RESULTS
  Multivariable models controlling for confounding by treatment indication found no significant differences between groups in implantation (MDF, 36%; LL, 38%), clinical pregnancy (MDF, 53%; LL, 56%), and live-birth rates (MDF, 47%; LL, 50%). No differences were observed in peak E(2), oocytes retrieved, oocyte maturity, fertilization rate, or embryos transferred.
  
  
  CONCLUSIONS
  MDF use among normal-responding ART patients produced no differences in cycle outcome when compared with LL. Therefore, MDF may be a viable alternative for normal-responding patients.
authors.affiliation: Walter Reed Army Medical Center ART Program, Washington, District of Columbia, USA. levense@mail.nih.gov
authors.forename: Eric D
authors.initials: ED
authors.lastname: Levens
authors.forename: Brian W
authors.initials: BW
authors.lastname: Whitcomb
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Kort
authors.forename: Donna
authors.initials: D
authors.lastname: Materia-Hoover
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Larsen
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D015331:Cohort Studies; D003338:Corpus Luteum / Q000187:drug effects / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D010064:Embryo Implantation / Q000187:drug effects / Q000502:physiology; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D016729:Leuprolide / Q000627:therapeutic use*; D015999:Multivariate Analysis; D054315:Oocyte Retrieval / Q000379:methods; D018579:Patient Selection; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
chemical_list: D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D004958:Estradiol; D016729:Leuprolide