Volume 16, Issue 4 (April 2018)                   IJRM 2018, 16(4): 260-255 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Davar R, Neghab N, Naghshineh E. Pregnancy outcome in delayed start antagonist versus microdose flare GnRH agonist protocol in poor responders undergoing IVF/ICSI: An RCT. IJRM. 2018; 16 (4) :260-255
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-1063-en.html
1- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2- Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , nosrat20@yahoo.com
Abstract:   (1062 Views)
Background: Over the years, many article on different aspects of pathogenesis and management of poor ovarian responders have been published but there is no clear guideline for treating themyet.
Objective: This study was designated to compare the effectiveness of a delayed start protocol with gonadotropin-releasing hormone (GnRH) antagonist and microdose flare-up GnRH agonist protocol in poor ovarian responders.
Materials and Methods: This randomized clinical trial consisted of 100 poor ovarian responder women in assisted reproductive technologies cycles. They were divided randomly in delayed-start antagonist protocol (with estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation) and microdose flare-up GnRH agonist protocol. The main outcome was clinical pregnancy rate and second outcome was the number of retrieved oocytes, mature oocytes, 2PN number, fertilization rate, and implantation rate.
Results: Fertilization rate, clinical pregnancy rate, and ongoing pregnancy rates were not significantly different between the two studied protocols. Number of retrieved oocytes (5.10±3.41 vs. 3.08±2.51) with p=0.002, mature oocytes (4.32±2.69 vs. 2.34±1.80) with p=0.003, number of 2PN (3.94±1.80 vs. 2.20±1.01) with p=0.001 and implantation rate (19.40% vs. 10.30%) with p=0.022 were significantly higher in delayed antagonist group.
Conclusion: The delayed-start protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle development.
Full-Text [PDF 307 kb]   (216 Downloads) |   |   Full-Text (HTML)  (148 Views)  
Type of Study: Original Article | Subject: Reproductive Biology

1. Younis JS, Ben-Ami M, Ben-Shlomo I. The Bologna criteria for poor ovarian response: a contemporary critical appraisal. J Ovar Res 2015; 8: 1-10. [DOI:10.1186/s13048-015-0204-9]
2. Cakmak H, Tran ND, Zamah AM, Cedars MI, Rosen MP. A novel "delayed start" protocol with gonadotropin-releasing hormone antagonist improves outcomes in poor responders. Fertil Steril 2014; 101: 1308-1314. [DOI:10.1016/j.fertnstert.2014.01.050]
3. Merviel P, Cabry-Goubet R, Lourdel E, Devaux A, Belhadri-Mansouri N, Copin H, et al. Comparative prospective study of 2 ovarian stimulation protocols in poor responders: effect on implantation rate and ongoing pregnancy. Reprod Health 2015; 12: 52-58. [DOI:10.1186/s12978-015-0039-2]
4. Demirol A, Gurgan T. Comparison of microdose flare-up and antagonist multiple-dose protocols for poor-responder patients: a randomized study. Fertil Steril 2009; 92: 481-485. [DOI:10.1016/j.fertnstert.2008.07.006]
5. Schoolcraft W, Schlenker T, Gee M, Stevens J, Wagley L. Improved controlled ovarian hyperstimulation in poor responder in vitro fertilization patients with a microdose follicle-stimulating hormone flare, growth hormone protocol. Fertil Steril 1997; 67: 93-97. [DOI:10.1016/S0015-0282(97)81862-6]
6. Davar R, Oskouian H, Ahmadi S, Firouzabadi RD. GnRH antagonist/letrozole versus microdose GnRH agonist flare protocol in poor responders undergoing in vitro fertilization. Taiwan J Obstet Gynecol 2010; 49: 297-301. [DOI:10.1016/S1028-4559(10)60064-2]
7. Dokras A, Sargent IL, Barlow DH. Human blastocyst grading: an indicator of developmental potential? Hum Reprod 1993; 8: 2119-2127. [DOI:10.1093/oxfordjournals.humrep.a137993]
8. Karimzadeh MA, Mashayekhy M, Mohammadian F, Moghaddam FM. Comparison of mild and microdose GnRH agonist flare protocols on IVF outcome in poor responders. Arch Gynecol Obstet 2011; 283: 1159-1164. [DOI:10.1007/s00404-010-1828-z]
9. Davar R, Rahsepar M, Rahmani E. A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients. Arch Gynecol Obstet 2013; 287: 149-153. [DOI:10.1007/s00404-012-2522-0]
10. Rosen MP, Shen S, Dobson AT, Rinaudo PF, McCulloch CE, Cedars MI. A quantitative assessment of follicle size on oocyte developmental competence. Fertil Steril 2008; 90: 684-690. [DOI:10.1016/j.fertnstert.2007.02.011]
11. Hill MJ, McWilliams GD, Miller KA, Scott RT, Frattarelli JL. A luteal estradiol protocol for anticipated poor-responder patients may improve delivery rates. Fertil Steril 2009; 91: 739-743. [DOI:10.1016/j.fertnstert.2007.12.073]
12. Fanchin R, Méndez Lozano DH, Schonäuer LM, Cunha-Filho JS, Frydman R. Hormonal manipulations in the luteal phase to coordinate subsequent antral follicle growth during ovarian stimulation. Reprod Biomed Online 2005; 10: 721-728. [DOI:10.1016/S1472-6483(10)61115-7]
13. Frankfurter D, Dayal M, Dubey A, Peak D, Gindoff P. Novel follicular-phase gonadotropin-releasing hormone antagonist stimulation protocol for in vitro fertilization in the poor responder. Fertil Steril 2007; 88: 1442-1445. [DOI:10.1016/j.fertnstert.2007.01.022]
14. Younis JS, Soltsman S, Izhaki I, Radin O, Bar-Ami S, Ben-Ami M. Early and short follicular gonadotropin-releasing hormone antagonist supplementation improves the meiotic status and competence of retrieved oocytes in in vitro fertilization-embryo transfer cycles. Fertili Steril 2010; 94: 1350-1355. [DOI:10.1016/j.fertnstert.2009.08.033]
15. Blockeel C, Riva A, De Vos M, Haentjens P, Devroey P. Administration of a gonadotropin-releasing hormone antagonist during the 3 days before the initiation of the in vitro fertilization/intracytoplasmic sperm injection treatment cycle: impact on ovarian stimulation. A pilot study. Fertil Steril 2011; 95: 1714-1719. [DOI:10.1016/j.fertnstert.2011.01.028]
16. Aflatoonian A, Hosseinisadat A, Baradaran R, Mojtahedi MF. Pregnancy outcome of "delayed start" GnRH antagonist protocol versus GnRH antagonist protocol in poor responders: A clinical trial study. Int J Reprod BioMed 2017; 15: 231-238. [DOI:10.29252/ijrm.15.4.231]

Add your comments about this article : Your username or Email:

Send email to the article author

© 2020 All Rights Reserved | International Journal of Reproductive BioMedicine

Designed & Developed by : Yektaweb