title: Stimulation of the young poor responder: comparison of the luteal estradiol/gonadotropin-releasing hormone antagonist priming protocol versus oral contraceptive microdose leuprolide.
abstract: OBJECTIVE
  To evaluate in vitro fertilization (IVF) cycle outcomes in young poor responders treated with a luteal estradiol/gonadotropin-releasing hormone antagonist (E(2)/ANT) protocol versus an oral contraceptive pill microdose leuprolide protocol (OCP-MDL).
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Academic practice.
  
  
  METHODS
  Poor responders: 186 women, aged <35 years undergoing IVF with either E(2)/ANT or OCP-MDL protocols.
  
  
  METHODS
  None.
  
  
  METHODS
  Clinical pregnancies, oocytes retrieved, cancellation rate.
  
  
  RESULTS
  Patients in the E(2)/ANT group had a greater gonadotropin requirement (71.9 ± 22.2 vs. 57.6 ± 25.7) and lower E(2) level (1,178.6 ± 668 vs. 1,627 ± 889), yet achieved similar numbers of oocytes retrieved and fertilized, and a greater number of embryos transferred (2.3 ± 0.9 vs. 2.0 ± 1.1) with a better mean grade (2.14 ± .06 vs. 2.7 ± 1.8) compared with the OCP/MDL group. The E2/ANT group exhibited a trend toward improved implantation rates (30.5% vs. 21.1%) and ongoing pregnancy rates per started cycle: 44 out of 117 (37%) versus 17 out of 69 (25%).
  
  
  CONCLUSIONS
  Poor responders aged <35 years may be treated with the aggressive E(2)/ANT protocol to improve cycle outcomes. Both protocols remain viable options for this group. Adequately powered, randomized clinical comparison appears justified.
authors.affiliation: Reproductive Medicine Associates of New Jersey, Morristown, New Jersey, USA. shefshastri@yahoo.com
authors.forename: Shefali M
authors.initials: SM
authors.lastname: Shastri
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barbieri
authors.forename: Isaac
authors.initials: I
authors.lastname: Kligman
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Schoyer
authors.forename: Owen K
authors.initials: OK
authors.lastname: Davis
authors.forename: Zev
authors.initials: Z
authors.lastname: Rosenwaks
mesh_terms: D000284:Administration, Oral; D000328:Adult; D015331:Cohort Studies; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage; D004304:Dosage Forms; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004958:Estradiol / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000008:administration & dosage*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage* / Q000494:pharmacology; D008183:Luteal Phase / Q000187:drug effects; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal; D004304:Dosage Forms; D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D016729:Leuprolide