GnRH antagonist multiple dose protocol with oral contraceptive pill pretreatment in poor responders undergoing IVF/ICSI / 대한생식의학회지

OBJECTIVE: To investigate the effectiveness of GnRH antagonist multiple-dose protocol (MDP) with oral contraceptive pill (OCP) pretreatment in poor responders undergoing IVF/ICSI, compared with GnRH antagonist MDP without OCP pretreatment and GnRH agonist low-dose long protocol (LP). METHODS: A total of 120 poor responders were randomized into three groups according to controlled ovarian stimulation (COS) options; GnRH antagonist MDP after OCP pretreatment (group 1), GnRH antagonist MDP without OCP pretreatment (group 2) or GnRH agonist luteal low-dose LP without OCP pretreatment (group 3). Patients allocated in group 1 were pretreated with OCP for 21days in the cycle preceding COS, and ovarian stimulation using recombinant human FSH (rhFSH) was started 5 days after discontinuation of OCP. RESULTS: There were no differences in patients' characteristics among three groups. Total dose and days of rhFSH used for COS were significantly higher in group 3 than in group 1 or 2. The numbers of mature oocytes, fertilized oocytes and grade I, II embryos were significantly lower in group 2 than in group 1 or 3. There were no significant differences in the clinical pregnancy rate and implantation rate among three groups. CONCLUSION: GnRH antagonist MDP with OCP pretreatment is at least as effective as GnRH agonist low-dose LP in poor responders and can benefit the poor responders by reducing the amount and duration of FSH required for follicular maturation.

The Efficacy of GnRH Antagonist Protocol in Controlled Ovarian Hyperstimulation of Poor Responders / 대한산부인과학회잡지

OBJECTIVE: This study was performed to estimate the efficacy of GnRH antagonist (cetrorelix) protocol in poor responders comparing with GnRH agonist protocol. METHODS: This study included 43 cycles of 38 patients who were defined as poor responders on previous consecutive two and more superovulation cycles. The study group consisted of 20 cycles of 18 poor responders treated with cetrorelix according to single dose protocol with clomiphene citrate, who were compared with 23 cycles of 20 poor responders (control group) stimulated according to GnRH agonist flare up protocol. RESULTS: Although the use of GnRH antagonist with clomiphene citrate gave a pregnancy rate of 15% which was in the range expected for patients with poor response, the study group had higher E2 level on hCG day (1246.5 +/- 89.4 vs 644.7 +/- 34.8 pg/ml) with higher number of mature oocytes (7.8 +/- 1.3 vs 4.3 +/- 0.5), and length of stimulation (15.5 +/- 1.4 vs 19.4 +/- 2.6 days), number of hMG ampules administered (19.4 +/- 3.2 vs 45.4 +/- 5.9 ampules), and cancellation rate (35.0 vs 47.8%) were significantly lower in the cetrorelix group. Although it was not statistically significant between two groups, the pregnancy rate (15 vs 8.6%) showed higher tendency in cetrorelix group. CONCLUSION: The use of GnRH antagonist cetrorelix ended with significantly more mature oocytes, less ampules of gonadotropin, shorter duration of stimulation and lower cancellation rate in this study. So the GnRH antagonist protocol may be an alternative protocol for the treatment of poor responders.

The Effectiveness of Lowdose Gonadotropin-Releasing Hormone Agonist and high dose hMG after Estrogen-Progesterone therapy in poor responder group to ovarian hyperstimulation / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of low dose gonadotropin releasing hormone agonist(GnRH-a) therapy combined with high dose human menopausal gonadotrpin(hMG) following estrogen & progesteron therapy for poor responders. METHODS: From May 1997 to Feb 1999, 36 patients who were defined as poor responders on previous consecutive two and more superovulation cycles were randomly allocated to lowdose GnRH-a short protocol with high dose hMG protocol pretreated with estrogen & progesterone(E/P therapy)(n=16)(study group) and the clomiphene citrate with hMG(n=20)(control group). All patients were planned to undergone in-vitro- fertilization(IVF) and embryo transfer(ET) after controlled ovarian hyperstimulation(COH). RESULTS: Two groups were similar with respect to clinical features and basal FSH and E2 levels. The mean level of E2 on day 5, 304.3+/-148.ng/ml in study group was significantly higher than that in control group, 182+/-34.9ng/ml. The mean levels of E2 on hCG day was also significantly higher in study group than control group(1324+/-320ng/ml, vs 414+/-168ng/ml). The mean day of hCG day in study group, 12.3+/-0.3 was shorter than that in control group, 13.8+/-0.4. The concellation rates of cycles were significantly lower in study group than control group(13.2% vs 84.2%). But clinical pregnancy rates did not showed the significant difference between two groups. CONCLUSION: The study suggested that a lowdose GnRH-a short protocol with high dose hMG pretreated with estrogen & progesterone can improve the ovarian response in poor responder group.