SUPPRESSION AND FLARE REGIMENS OF GONADOTROPIN-RELEASING-HORMONE AGONIST - USE IN WOMEN WITH DIFFERENT BASAL GONADOTROPIN VALUES IN AN IN-VITRO FERTILIZATION PROGRAM

OBJECTIVE: To evaluate the suppression and flare regimens of gonadotro pin-releasing hormone agonist (GnRH-a) in ovarian hyperstimulation in women with variable basal gonadotropin values in an in vitro fertiliza tion (IVF) program. STUDY DESIGN: A retrospective study comparing the initiation of GnRH-a in the midluteal phase of the preceding cycle (su ppression protocol) and follicular phase of the stimulated cycle (flar e protocol) in women with basal follicle-stimulating hormone (FSH) val es < 15 mIU/mL and greater than or equal to 15 mIU/mL. RESULTS: The pr egnancy rate per initiated cycle and implantation rate for women with basal FSH levels greater than or equal to 15 mIU/mL were 20.4% and 9.8 % in flare GnRH-a cycles and 11.7% and 3.5%, respectively, in suppress ion GnRH-a cycles. Comparing the percent differences in clinical pregn ancy and implantation rates between both protocols for women with diff erent basal FSH values, pregnancy outcome was significantly greater in the flare protocol in women with values greater than or equal to 15 m IU/mL (P < .001). Individualization of the stimulation protocol by ret rospective sorting of women undergoing IVF with respect to their basal gonadotropin levels significantly improved clinical pregnancy (P < .0 5) and implantation rates (P < .05) and reduced the cancellation rate (P < .05). CONCLUSION: The flare regimen with GnRH-a is a useful alter native for controlled ovarian hyperstimulation in women with elevated basal FSH values (greater than or equal to 15 mIU/mL) undergoing IVF.