A luteal estradiol protocol for anticipated poor-responder patients may improve delivery rates

Objective: To compare IVF data and outcomes between a standard protocol and a luteal phase E-2 protocol. Design: Retrospective cohort analysis. Setting(s): Large academic assisted reproduction technologies center. Patient(S): Fifty-seven infertile patients with a history of poor response to IVF stimulation and 228 matched control patients. Intervention(s): IVF with a standard protocol or a luteal phase E-2 protocol. Main Outcome Measure(s): Live-birth rates. Result(s): Patients in the luteal E-2 protocol required more days of stimulation and total gonadotropins and had higher peak E-2 levels when compared with the control group. The luteal E-2 protocol showed a greater percentage of embryos with >= 7 cells on day 3. A trend toward improved delivery rates was seen in the luteal E-2 protocol (28.1% vs. 22.4%; relative risk, 1.25, 0.78-2.03). Conclusion(S): A luteal E-2 protocol results in improved day 3 embryo development as demonstrated by the percent of embryos at the >= 7-cell stage. Likewise, the luteal E-2 protocol may ultimately improve pregnancy outcomes for patients with poor response to IVF stimulation. (Fertil Steril (R) 2009;91:739-43. (C) 2009 by American Society for Reproductive Medicine.)