USE OF THE FLARE-UP PROTOCOL WITH HIGH-DOSE HUMAN FOLLICLE-STIMULATING-HORMONE AND HUMAN MENOPAUSAL GONADOTROPINS FOR IN-VITRO FERTILIZATION IN POOR RESPONDERS

Objective: To analyze the effect of high dose human FSH in combination with hMG with a flare-up leuprolide acetate (LA) protocol in patients undergoing IVF at risk for a poor response. Design: Prospective. Sett ing: Free-standing ambulatory IVF center. Patients: Two hundred eighty -four patients underwent a LA screening test for IVF. Patients with a lack of flare response were considered at risk for a poor response and underwent ovarian stimulation with the flare-up LA protocol in combin ation with high dose human FSH and hMG. Results: The poor responder gr oup was compared with the good responders on the flare-up LA protocol and to patients undergoing ovulation induction with a luteal phase LA protocol. There were 53 poor responder flare-up LA cycles, 177 good re sponder flare-up LA cycles, and 54 luteal phase LA cycles. The cancell ation rate was higher in poor flare-up LA responders (11.3%) compared with good flare-up LA responders (1.1%) and luteal phase LA cycles (1. 8%). Peak E(2) levels, number of oocytes, and number of embryos were s ignificantly higher in the good flare-up LA responders. Fertilization rate was similar in all groups. Ongoing pregnancy rate per retrieval w as 28% in good responders, 29% in poor responders, and 33% in luteal p hase LA patients. Only one patient (0.4%) was hospitalized for severe ovarian hyperstimulation. Conclusion: The flare-up protocol with high- dose human FSH and hMG is a very good alternative for patients who are at high risk for a poor response. Although peak E(2) and number of oo cytes were significantly lower in this group, the patients who respond ed had the same fertilization and pregnancy rate as the good responder s. Cancellation rate remains high in poor responders.