Comparison of a gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist flare-up regimen in poor responders undergoing ovarian stimulation

Objective: To compare the efficacy of flare-up and GnRH-antagonist treatment in poor-responder patients. Design: Randomized prospective study. Setting: Assisted reproduction center. Patient(s): Fifty-five poor-responder patients undergoing intracytoplasmic sperm injection (ICSI). Intervention(s): Thirty patients received GnRH agonist on the 1st day of menstruation, followed by exogenous gonadotropins from the 2nd day. Twenty-five patients received exogenous gonadotropins starting on the second day of menstruation, followed by GnRH antagonist when the leading follicle reached 14 mm in diameter. Main Outcome Measure(s): The total dose of FSH administered during the ovarian stimulation, as well as the number of mature oocytes retrieved, embryo quality, fertilization, implantation, and pregnancy rates were evaluated. Result(s): The number of ampules and units of FSH administered were significantly less in the flare-up than in the antagonist group. The fertilization rate (8.4% vs. 63%) was significantly higher in the flare-up than in the GnRH-antagonist group. The implantation and pregnancy rate were similar in the two groups. Conclusion(s): The flare-up protocol appears to be more effective than the GnRH-antagonist protocol in terms of mature oocytes retrieved, fertilization rate, and top-quality embryos transferred in poor-responder patients.