COMPARISON OF A BLOCKING VS. A FLARE-UP PROTOCOL IN POOR RESPONDERS WITH A NORMAL AND ABNORMAL CLOMIPHENE CITRATE CHALLENGE TEST

This study aimed to standardize the clomiphene citrate test (CC-t) in our laboratory while comparing two different protocols of controlled o varian stimulation in poor responders. One hundred and forty-four pati ents scheduled for assisted reproductive techniques were submitted to the CC-t within 3 months before starting stimulation; 133 underwent co ntrolled ovarian stimulation with a blocking protocol. Poor responders in the first cycle (n = 30) were subsequently treated with a flare-up protocol. Although it was not statistically significant, move patient s reached oocyte retrieval with the flare-up protocol. In the complete d cycles, more gonadotropin ampules (55 +/- 15 vs. 34 +/- 13; p < 0.00 1) and move stimulation days (12.6 +/- 1 vs. 11.6 +/- 1.2; p < 0.005) weve needed in the blocking than in the flare-up protocol. No differen ce was observed in peak 17 beta-estradiol levels, preovulatory follicl es, oocytes retrieved or pregnancy rate between the two protocols. Acc ording to the threshold values, established on CC-t of patients who ob tained a clinical pregnancy (n = 44), the incidence of abnormal result s was 10%. All but one patient with abnormal CC-t were poor responders during the first stimulation cycle. The flare-up protocol did not imp rove the ovarian response in these patients.