The addition of estrogen to progesterone in a luteal phase support protocol in poor responding patients' IVF cycles: Results on pregnacy rates

Patients demonstrating poor ovarian response constitute an important fraction of infertile couples and in comparison to normoresponders exhibit lower in vivo and in vitro pregnancy rates. Patients characterized with poor ovarian response develop fewer follicles upon stimulation with gonadotropins; a quantitative and qualitative granulosa cell defiency leads to a defective production of sex steroids in the luteal phase. The aim of this study was to evaluate the effect of the use of luteal phase supplementary estrogen - a hormone of undeniable importance on endometrial receptivity and therefore implantation - on pregnancy rates among poor responding patients.We designed a prospective randomized controlled clinical study in 95 poor responding infertile patients at an IVF clinic between December 2008- June 2009. The cases were randomized into three luteal phase support groups on the day the stimulation protocols were determined. While group 1 was only to recieve transvaginal micronised progesterone; group 2 & 3 were designed in addition to progesterone, to receive 2 and 6 mg of estradiol hemihydrate, respectively.Poor responders given progesterone and 2 mg / day estrogen supplementation showed a higher rate of overall / total and clinical pregnancies compared to the control and 6 mg estrogen support groups.Key words: Poor ovarian response, luteal phase supplentation, estradiol, IVF.