Effects of different initiation day of hyperstimulation in oral contraceptive and microdose flare up protocols on induction parameters and pregnancy rates in poor responders undergoing intracytoplasmic sperm injection

EFFECTS OF DIFFERENT INITIATION DAY OF HYPERSTIMULATION IN ORALCONTRACEPTIVE AND MICRODOSE FLARE UP PROTOCOLS ON INDUCTIONPARAMETERS AND PREGNANCY RATES IN POOR RESPONDERS UNDERGOINGINTRACYTOPLASMIC SPERM ENJECTIONDR. GÜVEN GÜNAYDINSUMMARYOne hundred and forthy six poor responder patients were included in this prospectiverandomised controlled study and allocated in four groups by a computer generatedrandomization protocol. All patients received oral contraceptive pills for at least 21 days priorto ovarian stimulation. 37 patients were treated with microdose flare up regimen withstimulation started on the first day of their menstrual cycle (group 1), 49 patients were treatedwith microdose flare up regimen with stimulation started on the third day of their menstrualcycle (group 2) and 32 patients were treated with microdose flare up regimen with stimulationstarted on the fifth day of their menstrual cycle (group 3). Microdose GnRH agonistadministered 40 micrograms s.c. b.i.d. followed by high dose recombinant gonadotropininjections. Another group of 28 patients (group 4) received long luteal supression and highdose recombinant gonadotropins.In poor responders microdose flare-up regimes following oral contraceptivepretreatment sparing 4 days before stimulation resulted in increased maximum and hCG dayestradiol levels and endometrial thickness at hCG day without increasing cycle cancellationand premature progesterone surge rates but not increased pregnancy rates per cycle andtransfer and take home baby rates when compared with cases whom stimulation startedwithout sparing in the first day of cycle following oral contraceptive pretreatment.