COMPARISON BETWEEN CC/GNRH-ANT AND FLARE-UP GNRH AGONIST PROTOCOLS IN POOR OVARIAN RESPONDERS UNDERGOING ICSI

Bosoancă Ioan Cătălin, Marin Alina-Gabriela, Vlădăreanu Radu

Abstract:

Objective: To compare the efficacy of two protocols for ovarian stimulation in patients with poor ovarian reserve during in vitro fertilization (IVF) treatment. Methods: This retrospective observational study enrolled patients with poor ovarian reserve who underwent cycles of  intracytoplasmic sperm injection (ICSI). The patients were divided into two groups: (a) a flare-up gonadotropin releasing hormone (GnRH) agonist protocol (group A); (b) a mild stimulation protocol CC/GnRH-antagonist (group B). Demographic characteristics, clinical variables and treatment outcomes were compared between the two groups. Results: A total of 67 patients were enrolled in the study: 32 in group A and 35 in group B. Group B (20%) had a significantly higher cycle cancellation rate compared to group A (15.62%). There was no significant difference in mean age, body mass index, basal serum follicle-stimulating hormone and estradiol levels and antral follicle count. The days of stimulation, mean gonadotropin dose and oocytes retrieved and metaphase II oocytes retrieved, serum estradiol level on the day of human chorionic gonadotropin administration were significantly higher in group A. The fertilization rate and the number of embryos transferred were similar in both groups. The implantation rate was higher in the flare up group  and the total cancellation rate was higher in the GnRH antagonist/CC group, but these findings were not statistically significant. Conclusion: Although mild protocol is not superior to microdosed flare-up protocol in poor ovarian response patients, it may be used as an alternative protocol.

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