Comparison of initial IVF treatment protocols in patients over 35, whose FHS level is under <10 IU/L

In last 20 years a significant group of women who postponed their desire for pregnancy and now requesting reproductive treatments are getting older than 35 years. Controlled ovarian hyperstimulation is gonadotrophin induced stimulation of the ovaries for purposes of in vitro fertilisation treatment, which specifically aims at inducing ongoing multiple follicle development rather than a single dominant follicle in ovulatory women. The strategy behind using GnRH agonist/antagonist is to suppress pituitary gonadotrophin secretion and then to stimulate the follicular growth with gonadotrophins, thus facilitating cycle control. After age 35, decrease in oocyte quality and increase in follicle loss, brings reproductive aging and poor response to ovarian hyperstimulation. We included patients? initial IVF cycles retrospectively in Gazi University IVF Centre from 2004 to 2012. Patients were included who were over 35 years old and had no endocrinologic disorder, whose FSH level was <10 IU/L. Clinical pregnancy and live birth rates compared between hyperstimulation protocols; luteal long, antagonist and microdose flare-up. We tried to find the best stimulation protocol for women over 35. The patients who are under long protocol treatment were found more young and had more antral follicle. Number of oocyte and embriyo, hCG day estradiol level, endometrial thickness, clinical pregnancy rate and live birth rate was found higher in long protocol than the other protocols. Antagonist protocol results on clinical pregnancy and live birth rate was found similar with long protocol and beter than microdose protocol. If we consider total gonadotropin dose and days of stimulation, antagonist protocol was found favourable than microdose protocol. In advanced statistical analysis none of the protocols were found to have power to predict pregnancy. We found the factors; antral follicle count, age, number of oocytes retrieved and hCG day endometrial thickness, have power to predict the clinical pregnancy. Under these results we can use long protocol for patients who have more antral follicle and young, antagonist protocol for advanced age patients with short duration of stimulation and less gonadotropin dose. Because of these results, we advise to choose suitable ovarian hyperstimulation protocol under consideration of patients? characteristics like age, ovarian reserve and endocrinologic profile.