The comparison of the microdose GnRH agonist flare-up combined with gnrh antagonist flexible multi-dose and the gnrh antagonist protocol flexible multi-dose

Objective: The aim of this study is to compare the effectiveness of flexible multidose GnRH antagonist protocol which is frequently applied for the patients with poor response, and microdose GNRH agonist flare-up combined with flexible multidose GnRH antagonist protocol in poor responders Design: Retrospective study. Setting: Akdeniz University, Faculty of Medicine, Department of Obstetrics and Gynecology, IVF (in vitro fertilization) unit. Material and metod(s): All the patients, in ICSI-ET program between January 2006 and June 2012, were analysed retrospectively. The study was approved by the ethics committee of, Faculty of Medicine, Akdeniz University. Microdose GNRH agonist flare-up combined with flexible multidose GnRH antagonist protocol was applied to 41 patients (Group 1) and flexible multidose GnRH antagonist protocol was applied to 85 patients (Group 2). Totally 126 patients with poor ovarian response were selected. Total dose of FSH and hMG, total induction time, starting time of GnRH antagonist, the number of embryos greater than 16mm on hCG day, E2 level on hCG day, the number of oocytes collected on hCG day, oocyte maturation level, the number of embryos and their grade status, the number of embryos transferred, cycle cancellation rate, clinical pregnancy rate and pregnancies resulting in live births. Result(s): The cycle characteristics were similar in both groups. When COH (controlled ovarian hyperstimulation) results were compared, it was found that duration of the treatment was longer and the dose of FSH was higher in group 1(p< 0,05). Cancel rates were found as 29.3% in group 1, 35.7% in group 2. In the comparison of the laboratory results, there was no significant difference with respect to the number and quality of oocytes, number and quality of embryos obtained and the number of embryos transferred. Pregnancy rates were 4.9% in group 1, 14.1% in group 2. For group 1, there is one pregnancy resulting in live birth and the rate of living 2.4%. For group 2, this number is 5 including 1 twins. Conclusion(s): In this study, in the case of late reply (D8 de <10 mm follicle) and therefore most probably will result in the cancellation of cycle, analog was stopped with the aim of preventing the cancellation of cycle as well as to increase ovarian response, when the leading follicle is 12 mm, GnRH antagonist was added to prevent a possible premature LH rise to the treatment. As a result, with an alternative protocol to be started on late replying patients, similar results as multi-flexible-dose antagonist protocol were obtained. Although, our sample size is small and our study design is retrospective to make an aaurate conclusion, our study might be a start for larger and randomized studies in this special group of infertility patients.