title: Long gonadotropin-releasing hormone agonist versus short agonist versus antagonist regimens in poor responders undergoing in vitro fertilization: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the efficacy of the long GnRH agonist vs. the short GnRH agonist vs. the GnRH antagonist regimens in poor responders undergoing IVF.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Tertiary referral fertility units.
  
  
  METHODS
  Women with previous poor ovarian response undergoing IVF.
  
  
  METHODS
  One hundred eleven women were randomized to the long GnRH agonist, short agonist, and antagonist regimens.
  
  
  METHODS
  The primary outcome was the number of oocytes retrieved. Secondary outcome measures were gonadotropin consumption, duration of stimulation, cycle cancellation rate, mature oocytes retrieved, fertilization rate, cycles reaching ET, and clinical and ongoing pregnancy rates.
  
  
  RESULTS
  Number of oocytes retrieved was significantly higher with long GnRH agonist compared with the short agonist regimen (4.42 ± 3.06 vs. 2.71 ± 1.60), while there was no significant difference between long agonist and antagonist regimens (4.42 ± 3.06 vs. 3.30 ± 2.91). Duration of stimulation and total gonadotropin dose were significantly higher with long agonist compared with short agonist and antagonist regimens. The ongoing pregnancy rate was 8.1% with long and short agonist regimens and 16.2% with the antagonist regimen.
  
  
  CONCLUSIONS
  Long GnRH agonist and antagonist regimens offer a suitable choice for poor responders, whereas the short agonist regimen may be less effective because of fewer eggs retrieved.
authors.affiliation: Assisted Conception Unit, Guy's and St. Thomas' Foundation Trust, King's College London, United Kingdom. Electronic address: sksunkara@hotmail.com.
authors.forename: Sesh Kamal
authors.initials: SK
authors.lastname: Sunkara
authors.affiliation: Academic Unit, University of Birmingham, Birmingham Women's Hospital, Birmingham, United Kingdom.
authors.forename: Arri
authors.initials: A
authors.lastname: Coomarasamy
authors.affiliation: Lister Fertility Clinic, The Lister Hospital London, United Kingdom.
authors.forename: Raef
authors.initials: R
authors.lastname: Faris
authors.affiliation: Assisted Conception Unit, Guy's and St. Thomas' Foundation Trust, King's College London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Braude
authors.affiliation: Assisted Conception Unit, Guy's and St. Thomas' Foundation Trust, King's College London, United Kingdom.
authors.forename: Yacoub
authors.initials: Y
authors.lastname: Khalaf
mesh_terms: D000328:Adult; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005307:Fertilization in Vitro / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors* / Q000097:blood; D006062:Gonadotropins / Q000008:administration & dosage; D006801:Humans; D017274:Nafarelin / Q000008:administration & dosage; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D017274:Nafarelin; D007987:Gonadotropin-Releasing Hormone
keywords: GnRH antagonist regimen; Poor ovarian response; RCT; long GnRH agonist regimen; short GnRH agonist regimen