title: Comparative prospective study of 2 ovarian stimulation protocols in poor responders: effect on implantation rate and ongoing pregnancy.
abstract: BACKGROUND
  In patients treated with IVF, the incidence of poor ovarian response (POR) after ovarian stimulation varies from 9 to 25 %. However, at present, there are no clear guidelines for treating these poor responders. This study was designed to compare two different ovarian stimulation protocols and addresses future perspectives in the management of these unfortunate patients.
  
  
  METHODS
  Four hundred and forty poor responders were studied during their second IVF cycle. They had all failed to become pregnant during their first IVF cycle where the long GnRH-agonist stimulation protocol (P1) was used. Patients were prospectively randomly assigned to 2 protocol groups (P2 or P3, 220 patients in each arm) at the start of ovarian stimulation according to the order of entry into the study including one patient per each stimulation protocols: The P2 group was treated with a contraceptive pill + flare-up GnRH-agonist protocol and the P3 group with the GnRH-antagonist protocol. The ovarian stimulation characteristics as well as the clinical and ongoing pregnancy rates were compared.
  
  
  RESULTS
  Although the numbers of embryos obtained and transferred were significantly higher with the P2 protocol, the implantation and ongoing pregnancy rates per transfer were the same in the two studied groups (8.9 % versus 14.6 % and 8.4 % versus 14.2 % for the P2 and P3 protocols, respectively). Good prognostic factors for ongoing pregnancy with both protocols were: a maternal age <36, no tobacco consumption, a total dose of gonadotropins injection <5000 IU and an endometrial thickness >10 mm.
  
  
  CONCLUSIONS
  In poorly responding patients treated with IVF, the implantation and ongoing pregnancy rates per transfer were not significantly different between the two protocols studied: contraceptive pill + flare-up GnRH-agonist protocol and the GnRH-antagonist protocol. It is suggested that current strategies for the management of poor responders be reconsidered in the light of the potential contribution of age and the effect of life style changes on fertility potential. A customised policy of ovarian stimulation in these patients including mild stimulation protocols, sequential IVF cycles, oocytes-embryos freeze all protocols and blastocyst transfers after screening may improve the clinical outcome.
authors.affiliation: Department of Gynecology, Obstetrics and Reproductive Medicine, Amiens University Medical Center, 124 rue Camille Desmoulins, F-80054, Amiens cedex 1, France. Merviel.Philippe@chu-amiens.fr.|School of Medicine, University of Picardie Jules Verne, Chemin du Thil, 80025, Amiens cedex 1, France. Merviel.Philippe@chu-amiens.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Merviel
authors.affiliation: Reproductive Biology and Medical Cytogenetics Department, University Hospital, 124 rue Camille Desmoulins, F-80054, Amiens cedex 1, France. Cabry.Rosalie@chu-amiens.fr.|School of Medicine, University of Picardie Jules Verne, Chemin du Thil, 80025, Amiens cedex 1, France. Cabry.Rosalie@chu-amiens.fr.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Cabry-Goubet
authors.affiliation: Department of Gynecology, Obstetrics and Reproductive Medicine, Amiens University Medical Center, 124 rue Camille Desmoulins, F-80054, Amiens cedex 1, France. Lourdel.Emmanuelle@chu-amiens.fr.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Lourdel
authors.affiliation: Reproductive Biology and Medical Cytogenetics Department, University Hospital, 124 rue Camille Desmoulins, F-80054, Amiens cedex 1, France. avivadevaux@hotmail.com.|School of Medicine, University of Picardie Jules Verne, Chemin du Thil, 80025, Amiens cedex 1, France. avivadevaux@hotmail.com.
authors.forename: Aviva
authors.initials: A
authors.lastname: Devaux
authors.affiliation: Reproductive Biology and Medical Cytogenetics Department, University Hospital, 124 rue Camille Desmoulins, F-80054, Amiens cedex 1, France. Belhadri-Mansouri.Naima@chu-amiens.fr.|School of Medicine, University of Picardie Jules Verne, Chemin du Thil, 80025, Amiens cedex 1, France. Belhadri-Mansouri.Naima@chu-amiens.fr.
authors.forename: Naima
authors.initials: N
authors.lastname: Belhadri-Mansouri
authors.affiliation: Reproductive Biology and Medical Cytogenetics Department, University Hospital, 124 rue Camille Desmoulins, F-80054, Amiens cedex 1, France. Copin.Henri@chu-amiens.fr.|School of Medicine, University of Picardie Jules Verne, Chemin du Thil, 80025, Amiens cedex 1, France. Copin.Henri@chu-amiens.fr.
authors.forename: Henri
authors.initials: H
authors.lastname: Copin
authors.affiliation: Reproductive Biology and Medical Cytogenetics Department, University Hospital, 124 rue Camille Desmoulins, F-80054, Amiens cedex 1, France. Benkhalifamoncef78@gmail.com.|School of Medicine, University of Picardie Jules Verne, Chemin du Thil, 80025, Amiens cedex 1, France. Benkhalifamoncef78@gmail.com.
authors.forename: Moncef
authors.initials: M
authors.lastname: Benkhalifa
mesh_terms: D000328:Adult; D010064:Embryo Implantation / Q000187:drug effects*; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000037:antagonists & inhibitors*; D006801:Humans; D008297:Male; D008423:Maternal Age; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies
chemical_list: D007987:Gonadotropin-Releasing Hormone