title: Poor prognosis for ovarian response to stimulation: results of a randomised trial comparing the flare-up GnRH agonist protocol vs. the antagonist protocol.
abstract: OBJECTIVE
  To determine the efficacy of the flare-up agonist and the antagonist protocols in patients with poor prognosis for ovarian response.
  
  
  METHODS
  A randomised trial was conducted on two hundred and twenty-one women considered as having poor prognosis for ovarian response to stimulation, based on previous cycles or clinical criteria. All women were prospectively randomised into two groups of treatment (flare-up group and antagonist group) by computer-assisted randomisation in a 1:1 ratio. The main outcome measure was clinical pregnancy rate.
  
  
  RESULTS
  Groups were homogeneous in age and baseline characteristics. Duration of stimulation, gonadotropin consumption, number of oocytes retrieved and number and quality of embryos transferred did not differ significantly between the groups. E(2) level the day of hCG administration was significantly higher in the flare-up group. Pregnancy rates per started cycle were 15% in the flare-up group and 14.1% in the antagonist group. Cancellation rates were 12.5% in the flare-up group and 16.3% in the antagonist group. None of these differences reached statistical significance.
  
  
  CONCLUSIONS
  No statistically significant differences were observed between the two protocols regarding clinical pregnancy rates. In patients with poor prognosis for ovarian response, the flare-up agonist and the antagonist protocols were comparable regarding clinical pregnancy rates.
authors.affiliation: Department of Obstetrics and Gynaecology, Institut Universitari Dexeus, Barcelona, Spain. mardev@dexeus.com
authors.forename: Marta
authors.initials: M
authors.lastname: Devesa
authors.forename: Francisca
authors.initials: F
authors.lastname: Martínez
authors.forename: Buenaventura
authors.initials: B
authors.lastname: Coroleu
authors.forename: Rosa
authors.initials: R
authors.lastname: Tur
authors.forename: Clara
authors.initials: C
authors.lastname: González
authors.forename: Ignacio
authors.initials: I
authors.lastname: Rodríguez
authors.forename: Pedro N
authors.initials: PN
authors.lastname: Barri
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D004624:Embryo Transfer; D005260:Female; D037201:Follicle Stimulating Hormone, beta Subunit / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D010062:Ovulation Induction / Q000379:methods*; D018579:Patient Selection; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D037201:Follicle Stimulating Hormone, beta Subunit; D006727:Hormone Antagonists; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; C061018:ganirelix