title: Modified super-long down-regulation protocol improves fertilization and pregnancy in patients with poor ovarian responses.
abstract: BACKGROUND
  The successful end-point of in vitro fertilization (IVF) treatment is for a woman to give live birth. This outcome is based on various factors including adequate number of retrieved eggs. Failure to recruit adequate follicles, from which the eggs are retrieved, is called a "poor response". How to improve the clinical pregnancy rates of poor responders was one of the tough problems for IVF.
  
  
  METHODS
  The study involved 51 patients who responded poorly to high dose gonadotropin treatment in their previous cycles at our reproductive center, between April 2010 and February 2012. The previous cycle (group A) received routine long protocol; the subsequent cycle (group B) received modified super-long down-regulation protocol. The primary outcome of the study was the number of oocytes fertilized. The increase in the pregnancy rate was the secondary outcome. Differences between the groups were assessed by using Student's t test and c(2) test where appropriate.
  
  
  RESULTS
  The patients' average age was (36.64 ± 3.85) years. The mean duration of ovarian stimulation cycles of the group A patients was longer than those of the group B patients. The total dose of follicle-stimulating hormone (FSH) was significantly lower in the subsequent cycle. The peak value of serum estradiol on human chorionic gonadotrophin (hCG) day was lower in group A as compared with group B. The number of metaphase II oocytes recovered was significantly higher in group B. The cleavage rate in group A was significantly lower than in group B, 49 patients in group B reached embryo transfer stage, while 46 patients in group A reached this stage. Patients in group B received significantly more embryos per transfer as compared with group A. More pregnancies and more clinical pregnancies with fetal heart activity were achieved in group B.
  
  
  CONCLUSIONS
  This comparative trial shows that poor responder women undergoing repeated assisted reproduction treatment using modified super-long down-regulation protocol achieve more oocytes, leading to higher fertilization rate, compared to women receiving routine long protocol. Our study also showed that clinical pregnancy rate was significantly improved.
authors.affiliation: Reproductive Medicine Center, Department of Obstetrics and Gynaecology, General Hospital of Tianjin Medical University, Tianjin 300052, China.
authors.forename: Hui-Juan
authors.initials: HJ
authors.lastname: Zhang
authors.forename: Xue-Ru
authors.initials: XR
authors.lastname: Song
authors.forename: Rui
authors.initials: R
authors.lastname: Lü
authors.forename: Feng-Xia
authors.initials: FX
authors.lastname: Xue
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D004624:Embryo Transfer; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy
chemical_list: D006063:Chorionic Gonadotropin; D004958:Estradiol; D005640:Follicle Stimulating Hormone