ABSTRACT
Background: Microdose flare-up GnRH agonist and GnRH antagonist have becomemore popular in the management of poor ovarian responders [POR] in recent years;however, the optimal protocol for POR patients undergoing in vitro fertilization hasstill been a challenge
Methods: In this observational study design, two hundred forty four poor ovarian responderswere retrospectively evaluated for their response to GnRH agonist protocol[group-1, n=135] or GnRH antagonist protocol [group-2, n=109]. Clinical pregnancyrate was the primary end point and was compared between the groups. Student t-test,Mann Whitney U test and 2-test were used to compare the groups. The p<0.05 wasconsidered to show a statistically significant result
Results: The mean total gonadotropin doses were 3814 +/- 891 IU in group 1 and3539 +/- 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 andgroup 2, respectively were significantly different. The fertilization rate in group 1and group 2 was 73% vs. 68%, respectively [p=0.5] and clinical pregnancy rate was19.8% vs. 14.4%, respectively [p=0.13]
Conclusion: The GnRH agonist microdose flare-up protocol has favorable outcomeswith respect to the number of oocytes retrieved and implantation rate; nevertheless,the clinical pregnancy rate was found to be similar in comparison to GnRH antagonistprotocol in poor ovarian responders. GnRH antagonist protocol appears to bepromising with significantly lower gonadotropin requirement and lower treatmentcost in poor ovarian responders