RESUMEN
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
RESUMEN
OBJECTIVE: To study the effect of body composition on reproduction in women with unexplained infertility treated with a controlled ovarian hyperstimulation and intrauterine insemination programme. METHODS: This prospective observational study was conducted on 308 unexplained infertile women who were scheduled for a controlled ovarian hyperstimulation and intrauterine insemination programme and were grouped as pregnant and non-pregnant. Anthropometric measurements were performed using TANITA-420MA before the treatment cycle. Body composition was determined using a bioelectrical impedance analysis system. RESULTS: Body fat mass was significantly lower in pregnant women than in non-pregnant women (15.61+/-3.65 vs.18.78+/-5.97, respectively) (p=0.01). In a multiple regression analysis, body fat mass proved to have a stronger association with fecundity than the percentage of body fat, body mass index, or the waist/hip ratio (standardized regression coefficient> or =0.277, t-value> or =2.537; p<0.05). The cut-off value of fat mass, which was evaluated using the receiver operating characteristics curve, was 16.65 with a sensitivity of 61.8% and a specificity of 70.2%. Below this cut-off value, the odds of the pregnancy occurrence was found to be 2.5 times more likely. CONCLUSION: Body fat mass can be predictive for pregnancy in patients with unexplained infertility scheduled for a controlled ovarian hyperstimulation and intrauterine insemination programme.