title: A Flexible Multidose GnRH Antagonist versus a Microdose Flare-Up GnRH Agonist Combined with a Flexible Multidose GnRH Antagonist Protocol in Poor Responders to IVF.
abstract: OBJECTIVE
  To compare the effectiveness of a flexible multidose gonadotropin-releasing hormone (GnRH) antagonist against the effectiveness of a microdose flare-up GnRH agonist combined with a flexible multidose GnRH antagonist protocol in poor responders to in vitro fertilization (IVF).
  
  
  METHODS
  A retrospective study in Akdeniz University, Faculty of Medicine, Department of Obstetrics and Gynecology, IVF Center, for 131 poor responders in the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) program between January 2006 and November 2012. The groups were compared to the patients' characteristics, controlled ovarian stimulation (COH) results, and laboratory results.
  
  
  RESULTS
  Combination protocol was applied to 46 patients (group 1), and a single protocol was applied to 85 patients (group 2). In group 1, the duration of the treatment was longer and the dose of FSH was higher. The cycle cancellation rate was significantly higher in group 2 (26.1% versus 38.8%). A significant difference was not observed with respect to the number and quality of oocytes and embryos or to the number of embryos transferred. There were no statistically significant differences in the hCG positivity (9.5% versus 9.4%) or the clinical pregnancy rates (7.1% versus 10.6%).
  
  
  CONCLUSIONS
  The combination protocol does not provide additional efficacy.
authors.affiliation: Department of Obstetrics and Gynaecology, Akdeniz University Faculty of Medicine, 07058 Antalya, Turkey.
authors.forename: Gayem İnayet Turgay
authors.initials: Gİ
authors.lastname: Çelik
authors.affiliation: Department of Obstetrics and Gynaecology, Akdeniz University Faculty of Medicine, 07058 Antalya, Turkey.
authors.forename: Havva Kömür
authors.initials: HK
authors.lastname: Sütçü
authors.affiliation: Department of Obstetrics and Gynaecology, Ankara Mevki Military Hospital, 06110 Ankara, Turkey.
authors.forename: Yaşam Kemal
authors.initials: YK
authors.lastname: Akpak
authors.affiliation: Department of Obstetrics and Gynaecology, Akdeniz University Faculty of Medicine, 07058 Antalya, Turkey.
authors.forename: Münire Erman
authors.initials: ME
authors.lastname: Akar
mesh_terms: D000328:Adult; D004305:Dose-Response Relationship, Drug; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000187:drug effects*; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000819:agonists / Q000037:antagonists & inhibitors; D006062:Gonadotropins / Q000378:metabolism*; D006801:Humans; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic
chemical_list: D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone