Comparison of microdose and standard doses of GnRH analogue in flare protocols for controlled ovarian hyperstimulation in poor responders.

Objective: The purpose of the study was to compare the efficacy of two different regimens; microdose and standard doses for the use of GnRH analogue, in the management of poor responders. Design: A retrospective analysis was performed on the data obtained from the files of 137 women who demonstrated poor ovarian reserve and signed into assisted reproductive techniques (ART) with flare protocol. Materials/Methods: GnRH analogue was used as microdoses in 54 and as standard doses in 83 cycles for controlled ovarian hyperstimulation. In the microdose protocol, 40 micrograms leuprolide acetate b.i.d was started 3 days after the discontinuation of oral contraceptive usage for 21 days. In the standard dose flare-up regimen, 400 milligrams nafarelin was started on cycle day 2 in combination with gonadotropin and the dose is decreased to 200 milligrams per day on cycle day 6. In both groups, urinary FSH and HMG combination was started according to the body mass index and the dose is decreased in a step-down manner according to follicular growth. The laboratory and clinical results were compared in both groups. Results: In the microdose group, 8 cycles were cancelled (14.8%) due to inadequate follicular response. In the standard dose flare group, 16 cycles were cancelled (19.3%); 11 (13.2%) due to failed follicular growth and 5 (6.1%) due to premature LH surge. There was no statistically significant difference between two regimens in terms of age and basal FSH levels. The duration of induction was significantly longer and more gonadotropin ampules were used in the microdose regimen (p , 0.001). The peak estradiol level was higher with increased yield of M-II oocytes in the microdose group (p , 0.01 and p , 0.05, respectively). No premature LH surge was seen in the microdose regimen. For the microdose and co-flare regimens, the overall pregnancy rate per embryo transfer were 28% and 16%, respectively (p , 0.05).