title: A novel "delayed start" protocol with gonadotropin-releasing hormone antagonist improves outcomes in poor responders.
abstract: OBJECTIVE
  To investigate whether delaying the start of ovarian stimulation with GnRH antagonist improves ovarian response in poor responders.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Thirty patients, who responded poorly and did not get pregnant with conventional estrogen priming antagonist IVF protocol.
  
  
  METHODS
  Delayed-start antagonist protocol (estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation).
  
  
  METHODS
  Number of dominant follicles and mature oocytes retrieved, mature oocyte yield, and fertilization rate.
  
  
  RESULTS
  The number of patients who met the criteria to proceed to oocyte retrieval was significantly higher in the delayed-start protocol [21/30 (70%)] compared with the previous conventional estrogen priming antagonist cycle [11/30 (36.7%)]. The number of dominant follicles was significantly higher in the delayed-start (4.2 ± 2.7) compared with conventional (2.4 ± 1.3) protocol. In patients who had oocyte retrieval after both protocols (n = 9), the delayed start resulted in shorter ovarian stimulation (9.4 ± 1.4 days vs. 11.1 ± 2.0 days), higher number of mature oocytes retrieved (4.9 ± 2.0 vs. 2.2 ± 1.1), and a trend toward increased fertilization rates with intracytoplasmic sperm injection (ICSI; 86 ± 17% vs. 69 ± 21%) compared with conventional protocol. After delayed start, the average number of embryos transferred was 2.8 ± 1.4 with implantation rate of 9.8% and clinical pregnancy rate of 23.8%.
  
  
  CONCLUSIONS
  The delayed-start protocol improves ovarian response in poor responders by promoting and synchronizing follicle development without impairing oocyte developmental competence.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
authors.forename: Hakan
authors.initials: H
authors.lastname: Cakmak
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
authors.forename: Nam D
authors.initials: ND
authors.lastname: Tran
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
authors.forename: A Musa
authors.initials: AM
authors.lastname: Zamah
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California. Electronic address: rosenm@obgyn.ucsf.edu.
authors.forename: Mitchell P
authors.initials: MP
authors.lastname: Rosen
mesh_terms: D000328:Adult; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors* / Q000097:blood; D006727:Hormone Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000097:blood / Q000628:therapy*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone
keywords: Delayed start; controlled ovarian stimulation; poor responder