title: Microdose Flare-up Gonadotropin-releasing Hormone (GnRH) Agonist Versus GnRH Antagonist Protocols in Poor Ovarian Responders Undergoing Intracytoplasmic Sperm Injection.
abstract: BACKGROUND
  Microdose flare-up GnRH agonist and GnRH antagonist have become more popular in the management of poor ovarian responders (POR) in recent years; however, the optimal protocol for POR patients undergoing in vitro fertilization has still been a challenge.
  
  
  METHODS
  In this observational study design, two hundred forty four poor ovarian responders were retrospectively evaluated for their response to GnRH agonist protocol (group-1, n=135) or GnRH antagonist protocol (group-2, n=109). Clinical pregnancy rate was the primary end point and was compared between the groups. Student t-test, Mann Whitney U test and χ (2)-test were used to compare the groups. The p<0.05 was considered to show a statistically significant result.
  
  
  RESULTS
  The mean total gonadotropin doses were 3814±891 IU in group 1 and 3539±877 IU in group 2 (p=0.02). The number of metaphase-II oocytes (3.6±2.4 vs. 2.8±1.9, p=0.005) and implantation rates (27.8% vs. 18.8%, p=0.04) in group 1 and group 2, respectively were significantly different. The fertilization rate in group 1 and group 2 was 73% vs. 68%, respectively (p=0.5) and clinical pregnancy rate was 19.8% vs. 14.4%, respectively (p=0.13).
  
  
  CONCLUSIONS
  The GnRH agonist microdose flare-up protocol has favorable outcomes with respect to the number of oocytes retrieved and implantation rate; nevertheless, the clinical pregnancy rate was found to be similar in comparison to GnRH antagonist protocol in poor ovarian responders. GnRH antagonist protocol appears to be promising with significantly lower gonadotropin requirement and lower treatment cost in poor ovarian responders.
authors.affiliation: Goztepe Research and Training Hospital, Kadikoy, Istanbul, Turkey.
authors.forename: Aysen
authors.initials: A
authors.lastname: Boza
authors.affiliation: Zeynep Kamil Maternity and Children Research and Training Hospital, Uskudar, Istanbul, Turkey.
authors.forename: Erbil
authors.initials: E
authors.lastname: Cakar
authors.affiliation: Zeynep Kamil Maternity and Children Research and Training Hospital, Uskudar, Istanbul, Turkey.
authors.forename: Barıs
authors.initials: B
authors.lastname: Boza
authors.affiliation: Zeynep Kamil Maternity and Children Research and Training Hospital, Uskudar, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Api
authors.affiliation: Zeynep Kamil Maternity and Children Research and Training Hospital, Uskudar, Istanbul, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Kayatas
authors.affiliation: Zeynep Kamil Maternity and Children Research and Training Hospital, Uskudar, Istanbul, Turkey.
authors.forename: Kenan
authors.initials: K
authors.lastname: Sofuoglu
keywords: Agonist; Antagonist; Flare-up; Poor responder