title: Delayed Start Versus Conventional GnRH Antagonist Protocol in Poor Responders Pretreated With Estradiol in Luteal Phase: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To compare the new delayed start protocol against the conventional gonadotropin (Gn)-releasing hormone antagonist protocol in poor responders (PORs).
  
  
  METHODS
  A total of 160 women with poor response to previous in vitro fertilization (IVF) cycle were randomized either to start Gn then Cetrotide 0.25 subcutaneously (sc) added when leading follicle (DF) reach >12 mm or Cetrotide 0.25 mg sc started first from day 2 to day 8 then Gn therapy was added and Cetrotide restarted when DF reach >12 mm.
  
  
  RESULTS
  There was a statistically significant difference between conventional and delayed start protocols regarding the needed dose of Gn for stimulation (4368 ± 643 and 3798 ± 515), level of estradiol (E2; 778 ± 371 and 1076 ± 453), and endometrial thickness at human chorionic gonadotropin triggering (8.6 ± 1.8 and 9.8 ± 1.9), the number of DF (3.4 ± 1.5 and 4.9 ± 2.1), the number of retrieved follicles (2.4 ± 2.1 and 4.3 ± 2.5), and successful embryo transfer (13 vs 16), respectively (P < .05). There was a highly statistically significant difference between the 2 study groups regarding the number of oocytes fertilized (1.2 ± 2.0 vs 3.3 ± 1.4), metaphase II oocytes (0.9 ± 1.0 vs 2.7 + 1.6), and grade I embryos (0.7 ± 0.9 vs 2.1 + 1.1; P < .001). The chemical pregnancy, clinical pregnancy, and abortion rate showed a statistically significant difference between the 2 study groups (P value .003 and .006, respectively).
  
  
  CONCLUSIONS
  Delayed start protocol significantly improved clinical pregnancy rate and IVF cycle parameters in PORs.
authors.affiliation: Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University, Giza, Egypt prof.ahmedmaged@gmail.com.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Maged
authors.affiliation: Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University, Giza, Egypt.
authors.forename: Adel M
authors.initials: AM
authors.lastname: Nada
authors.affiliation: Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University, Giza, Egypt.
authors.forename: Fouad
authors.initials: F
authors.lastname: Abohamila
authors.affiliation: Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University, Giza, Egypt.
authors.forename: Ahmed T
authors.initials: AT
authors.lastname: Hashem
authors.affiliation: Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University, Giza, Egypt.
authors.forename: Walaa Ai
authors.initials: WA
authors.lastname: Mostafa
authors.affiliation: Obstetrics and Gynecology Department, Kasr Aini Hospital, Cairo University, Giza, Egypt.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: Elzayat
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D004334:Drug Administration Schedule; D004534:Egypt; D004624:Embryo Transfer; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005298:Fertility / Q000187:drug effects*; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008183:Luteal Phase; D054315:Oocyte Retrieval; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012529:Saudi Arabia; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; C062876:cetrorelix
keywords: GnRH antagonist; conventional protocol; delayed start protocol; poor responders