Faculty Collaboration Database

Stimulation of the young poor responder: comparison of the luteal estradiol/gonadotropin-releasing hormone antagonist priming protocol versus oral contraceptive microdose leuprolide. Fertil Steril 2011 Feb;95(2):592-5

Date

11/16/2010

Pubmed ID

21074154

DOI

10.1016/j.fertnstert.2010.10.003

Scopus ID

2-s2.0-78751593323 (requires institutional sign-in at Scopus site)   38 Citations

Abstract

OBJECTIVE: To evaluate in vitro fertilization (IVF) cycle outcomes in young poor responders treated with a luteal estradiol/gonadotropin-releasing hormone antagonist (E(2)/ANT) protocol versus an oral contraceptive pill microdose leuprolide protocol (OCP-MDL).

DESIGN: Retrospective cohort.

SETTING: Academic practice.

PATIENT(S): Poor responders: 186 women, aged <35 years undergoing IVF with either E(2)/ANT or OCP-MDL protocols.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): Clinical pregnancies, oocytes retrieved, cancellation rate.

RESULT(S): Patients in the E(2)/ANT group had a greater gonadotropin requirement (71.9 ± 22.2 vs. 57.6 ± 25.7) and lower E(2) level (1,178.6 ± 668 vs. 1,627 ± 889), yet achieved similar numbers of oocytes retrieved and fertilized, and a greater number of embryos transferred (2.3 ± 0.9 vs. 2.0 ± 1.1) with a better mean grade (2.14 ± .06 vs. 2.7 ± 1.8) compared with the OCP/MDL group. The E2/ANT group exhibited a trend toward improved implantation rates (30.5% vs. 21.1%) and ongoing pregnancy rates per started cycle: 44 out of 117 (37%) versus 17 out of 69 (25%).

CONCLUSION(S): Poor responders aged <35 years may be treated with the aggressive E(2)/ANT protocol to improve cycle outcomes. Both protocols remain viable options for this group. Adequately powered, randomized clinical comparison appears justified.

Author List

Shastri SM, Barbieri E, Kligman I, Schoyer KD, Davis OK, Rosenwaks Z

Author

Katherine Schoyer MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Administration, Oral
Adult
Cohort Studies
Contraceptives, Oral, Hormonal
Dosage Forms
Dose-Response Relationship, Drug
Drug Administration Schedule
Estradiol
Female
Fertility Agents, Female
Gonadotropin-Releasing Hormone
Hormone Antagonists
Humans
Leuprolide
Luteal Phase
Ovulation Induction
Pregnancy
Pregnancy Rate
Retrospective Studies
Treatment Failure
Young Adult