title: The comparision of effect of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients.
abstract: OBJECTIVE
  To compare the effects of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients.
  
  
  METHODS
  Of 225 patients, 83 patients were in microdose flare-up group (Group 1), 70 patients were in GnRH antagonist/letrozole group (Group 2) and 72 patients were in GnRH antagonist/clomiphene citrate group (Group 3). Demographic and endocrine characteristics, the total number of oocytes retrieved, cancellation rate and clinical pregnancy rate were collected Results: Total dosage of gonadotropins (p=0.002) and serum E2 levels on the day of hCG administration (p=0.010) were significantly higher and duration of stimulations (p=0.03) was significantly longer in group 1. The number of oocytes retrieved was significantly greater in group 1 and 2 when compare to those of group 3 (p=0,000). There was a trend towards increasing cycle cancellation rates with GnRH antagonist/clomiphene citrate and GnRH antagonist/letrozole.
  
  
  CONCLUSIONS
  Our finding suggest that the results of microdose flare-up protocol are better than other two used treatment protocols, in terms of maximum estradiol levels, number of mature oocytes retrieved, and cancellation rate and it still seems to be superior the ovarian stimulation regime for the poor responder patients.
authors.affiliation: Yeditepe University Hospital, Obstetrics and Gynecology , Devlet Yolu, Kozyatagi, Istanbul , Turkey .
authors.forename: Pinar
authors.initials: P
authors.lastname: Ozcan Cenksoy
authors.forename: Cem
authors.initials: C
authors.lastname: Ficicioglu
authors.forename: Ozge
authors.initials: O
authors.lastname: Kizilkale
authors.forename: Mehmet
authors.initials: M
authors.lastname: Suhha Bostanci
authors.forename: Murat
authors.initials: M
authors.lastname: Bakacak
authors.forename: Mert
authors.initials: M
authors.lastname: Yesiladali
authors.forename: Cigdem
authors.initials: C
authors.lastname: Kaspar
mesh_terms: D000328:Adult; D047072:Aromatase Inhibitors / Q000008:administration & dosage; D002996:Clomiphene / Q000008:administration & dosage*; D004958:Estradiol / Q000097:blood; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D000077289:Letrozole; D009570:Nitriles / Q000008:administration & dosage*; D054315:Oocyte Retrieval; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D018709:Statistics, Nonparametric; D014230:Triazoles / Q000008:administration & dosage*; D014463:Ultrasonography
chemical_list: D047072:Aromatase Inhibitors; D009570:Nitriles; D014230:Triazoles; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D000077289:Letrozole
keywords: Assisted Reproductive Technology; infertility; ovulation induction