Microdose flare protocol with interrupted follicle stimulating hormone and added androgen for poor responders--an observational pilot study.
OBJECTIVE
To investigate whether temporarily withholding FSH and adding androgen could improve follicular response during a microdose flare protocol in women with slow follicular growth or asynchronous follicular development.


METHODS
Observational pilot study.


METHODS
University-affiliated private fertility center.


METHODS
Twenty-six women aged 34-47 years with poor response to stimulation or a previous cancelled IVF cycle and with slow or asynchronous follicular growth during a microdose flare cycle.


METHODS
For 13 women, after initiation of ovarian stimulation using the microdose flare protocol, gonadotropin administration was interrupted and transdermal testosterone gel was added for several days (4.4 ± 1.2 d) starting after cycle day 7 (mean cycle day 10 ± 2.6).


METHODS
FSH, E2, follicular growth, and total number of mature oocytes retrieved were determined for all of the patients. Cycle cancellation rate as well as pregnancy rate following embryo transfer were also documented when applicable.


RESULTS
FSH levels declined (25.2 ± 6.5 to 6.8 ± 3.2 IU/L), E2 levels increased (896 ± 687 to 2,163 ± 1,667 pmol/L), and follicular growth improved significantly during gonadotropin interruption and were tracked for 2 days during this time frame. The average number of oocytes retrieved was 5.3 ± 2.6, and the ratio of mature to total oocytes was 4:5. Four of the 13 women in the interruption group conceived following frozen embryo transfer, whereas none in the control group did.


CONCLUSIONS
The androgen-interrupted FSH protocol may improve follicular response to gonadotropins in cycles that might otherwise be cancelled.
TCART Fertility Partners, Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Frederic
F
Mitri
TCART Fertility Partners, Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Lucy Ann
LA
Behan
School of Medicine, Trinity College Dublin, Dublin, Ireland.
Courtney A
CA
Murphy
TCART Fertility Partners, Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Anat
A
Hershko-Klement
TCART Fertility Partners, Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
Robert F
RF
Casper
TCART Fertility Partners, Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Toronto, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: ybentov@tcart.ca.
Yaakov
Y
Bentov
D000279:Administration, Cutaneous; D000328:Adult; D000728:Androgens / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004624:Embryo Transfer; D005260:Female; D005298:Fertility / Q000187:drug effects; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D005782:Gels; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D054315:Oocyte Retrieval; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D010865:Pilot Projects; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013739:Testosterone / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D000728:Androgens; D005300:Fertility Agents, Female; D005782:Gels; D013739:Testosterone; D005640:Follicle Stimulating Hormone
Androgen; gonadotropin resistance; interrupted protocol; microdose flare; poor responder