title: Effect of estrogen priming through luteal phase and stimulation phase in poor responders in in-vitro fertilization.
abstract: OBJECTIVE
  To verify whether a novel protocol administering E(2) during the luteal phase of the preceding cycle and during ovarian stimulation in GnRH antagonist cycle could enhance follicular response and hence improve outcomes in poor responders.
  
  
  METHODS
  In this retrospective analysis, a total of 155 poor responder patients subjected to IVF/ICSI were analyzed. All the patients had history of more than one prior IVF cycle failure with poor response (less than 5 oocytes retrieved and/or maximal E₂ level less than 500 pg/mL) by using conventional long agonist or antagonist protocol. In luteal E2 treatment protocol (n = 86), oral estradiol valerate 4 mg/day was initiated on luteal day 21 and either stopped at menstrual cycle day 3 (Protocol A, n = 28) or continued during the period of ovarian stimulation until the day of hCG injection (Protocol B, n = 58). IVF parameters and pregnancy outcome of luteal E2 treatments group were compared with a standard GnRH antagonist protocol (n = 69) which the patients received no hormonal pretreatment.
  
  
  RESULTS
  Compared to standard GnRH antagonist protocol, cancellation rate was lower with luteal E2 group (15.1% vs 37.7%, p < 0.01). Moreover, patients treated with luteal estrogen resulted in an increased number of oocytes retrieved (4.5 ± 2.9 vs 3.2 ± 1.9; p < 0.01). A trend toward increase in number of normally fertilized embryos (2.9 ± 2.1vs 2.3 ± 1.9; p = 0.043), and increased prevalence of good quality embryos (51.2% vs 25%; p = 0.047) were noted. Comparing protocol A and B, there were no significant difference between embryologic data, however there were slight increase in ongoing pregnancy rate in protocol B compared to A (27.1% vs 20%, p = 0.357), although statistical significance was not achieved.
  
  
  CONCLUSIONS
  Estrogen priming through luteal phase and stimulation phase improved ovarian responsiveness and this may lead to an increase in pregnancy rate in poor responders with failed cycle.
authors.affiliation: Fertility Center of CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, College of Medicine, CHA University, 650-9 Yeoksam, Kangnamgu, Seoul 135-081, Korea.
authors.forename: Eun Mi
authors.initials: EM
authors.lastname: Chang
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Han
authors.forename: Hyung Jae
authors.initials: HJ
authors.lastname: Won
authors.forename: You Shin
authors.initials: YS
authors.lastname: Kim
authors.forename: Tae Ki
authors.initials: TK
authors.lastname: Yoon
authors.forename: Woo Sik
authors.initials: WS
authors.lastname: Lee
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004351:Drug Resistance; D004477:Ectogenesis / Q000187:drug effects; D004958:Estradiol / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000097:blood / Q000494:pharmacology; D004967:Estrogens / Q000008:administration & dosage* / Q000097:blood / Q000494:pharmacology; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000494:pharmacology; D006801:Humans; D007246:Infertility / Q000097:blood / Q000628:therapy*; D008183:Luteal Phase / Q000187:drug effects*; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies
chemical_list: D004967:Estrogens; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol