CESSATION OF GONADOTROPIN-RELEASING-HORMONE AGONIST THERAPY COMBINED WITH HIGH-DOSE GONADOTROPIN STIMULATION YIELDS FAVORABLE PREGNANCY RESULTS IN LOW RESPONDERS

Objective: To evaluate the pregnancy results of an ovarian hyperstimul ation protocol for IVF-ET that combines GnRH agonist down-regulation, cessation of GnRH agonist therapy with the onset of menstruation, and high-dose gonadotropin administration in low responders. Design: Prosp ective analysis. Setting: Academic IVF program. Patient(s): One hundre d eighty-two low responders undergoing 224 IVF-ET cycles. Intervention (s): Down-regulation was obtained with the administration of leuprolid e ocetate beginning in the midluteal phase and ending with the onset o f menses. Daily administration of 6 ampules of FSH alone or in combina tion with hMG was initiated on cycle day 3. Main Outcome Measure(s): S timulation characteristics and pregnancy rates (PRs) were compared bet ween fresh cycles in which purr FSH alone was used and 35 cycles in wh ich a combination of FSH and hMG was administered. Result(s): The clin ical PR per transfer, the ongoing PR per transfer. and the implantatio n rate were 32%, 24%, and 9%, respectively. No differences were noted between cycles in which pure FSH alone was used in comparison with cyc les in which a combination of FSH and hMG was administered. Conclusion (s): Short-term ovarian suppression begun in the luteal phase and disc ontinued with the onset of menses followed by high-dose stimulation wi th gonadotropins yields favorable pregnancy results in low responders. (C) 1998 by American Society for Reproductive Medicine.