Antagonist/letrozole protocol in poor ovarian responders for intracytoplasmic sperm injection: a comparative study with the microdose flare-up protocol.
OBJECTIVE
To compare the effect of the GnRH antagonist/letrozole protocol (AL) with the microdose GnRH agonist flare-up (MF) protocol in poor ovarian responders for intracytoplasmic sperm injection (ICSI).


METHODS
Retrospective, case-control study.


METHODS
Anatolia Women and IVF Center.


METHODS
Eight hundred eighty-five consecutive patients (1383 cycles) predicted to have or with a history of poor ovarian response who were undergoing ICSI were enrolled. The MF protocol was used in 673 patients (1026 cycles), and the AL protocol was used in the remaining 212 patients (357 cycles).


METHODS
Controlled ovarian hyperstimulation and ICSI.


METHODS
Cycle cancellation rate, number of oocytes retrieved, fertilization rate, embryo quality, clinical pregnancy, and implantation rates.


RESULTS
The total gonadotropin consumption, duration of stimulation, E(2) level on the day of hCG administration, and number of oocytes retrieved were significantly lower with the AL protocol compared with the MF protocol. However, the fertilization rate and the rate of at least one top-quality embryo transferred were higher with the AL compared with the MF protocol. The clinical pregnancy rates were comparable between the two groups. The implantation rates with the MF and AL protocols were 9.8% and 14.5%, respectively.


CONCLUSIONS
The GnRH AL protocol is an effective protocol that may be used in poor ovarian responders for ICSI.
Yarali
Hakan
H
Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey. hyarali@hacettepe.edu.tr
Esinler
Ibrahim
I
Polat
Mehtap
M
Bozdag
Gurkan
G
Tiras
Bulent
B
D000328:Adult; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D004958:Estradiol / Q000097:blood; D004964:Estriol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D000077289:Letrozole; D009570:Nitriles / Q000627:therapeutic use*; D006080:Ovarian Follicle / Q000503:physiopathology; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D014230:Triazoles / Q000627:therapeutic use*
D047072:Aromatase Inhibitors; D009570:Nitriles; D011994:Recombinant Proteins; D014230:Triazoles; D004958:Estradiol; D000077289:Letrozole; D005640:Follicle Stimulating Hormone; D004964:Estriol