The use of GnRH antagonist in ovarian stimulation for IVF cycles can achieve good pregnancy rates in poor responder patients

Introduction: Some patients exhibit a poor ovarian response when stimulated for IVF. Poor ovarian response limits the success of assisted reproduction treatment. These patients require a specific stimulation regimen as well as a better stimulation protocol. In these cases, oocyte quantity as well as fertilization and implantation rates might be impaired. The aim of this multicentric, prospective study is to evaluate in poor responder patients the efficacy of GnRH antagonist in comparison with the standard long protocol. Materials and methods: A total of 40 patients, who presented a poor ovarian response in previous treatment cycles (mean age SD: 40 3.6 years; range 36–44), was studied. They were divided into two groups: group I (n 20) was stimulated with a standard long protocol using down-regulation by GnRH analogues and a stimulation dose of 375 IU recombinant FSH. Group II (n 20) received 375 IU of recombinant FSH from day 2 of the cycle and GnRH antagonist cetrorelix (Cetrotide) was administrated from day 5 until the day of HCG administration. At day 8 of the cycle were added 75 IU of LH (Luveris) daily injection to improve the ovarian response in both groups. Estradiol analysis and vaginal ultrasounds were performed to evaluate the ovarian response. In cases of severe male factor, IVF was performed by ICSI. Results: The following results were obtained after 40 stimulated cycles: in group II the mean duration of stimulation was shorter (10.5 days) than that in group I (13.5 days) and a reduced number of ampoules was used; numbers, grade and quality of embryos transferred were comparable between two treatments; fewer cycles were cancelled with the antagonist protocol (5.0% with antagonist versus 20.0% with agonist); three pregnancies were obtained with the GnRH antagonist protocol (15.0% per cycles started) and one with the GnRH agonist protocol (5.0% per cycle started). Conclusions: These data indicate that the use of GnRH antagonist multiple dose protocol allows the achievement of good results in terms of pregnancy rate using significantly fewer ampoules of gonadotrophins and a shorter duration of stimulation. This treatment could be the protocol of choice for poor responder patients even if it needs to be further evaluated in a future randomized study.