Cessation of gonadotropin-releasing hormone analogue (GnRH-a) upon downregulation versus conventional long GnRH-a protocol in poor responders undergoing in vitro fertilization

Objective: To determine whether a controlled ovarian hyperstimulation (COH) regimen that involves GnRH agonist (GnRH-a) discontinuation before adminis tration of gonadotropins would benefit poor responders. Design: A prospective, randomized controlled trial. Setting: Hospital-based IVF Unit. Patient(s): Sixty-three patients with previous poor response to COH and/or high basal FSH level (greater than or equal to 9 mIU/mL) undergoing 78 IVF- ET cycles. Intervention(s): In both groups, administration of GnRH-a was started in th e midluteal phase. Whereas in the study group (40 cycles), it ended before administration of gonadotropins, in controls (38 cycles) GnRH-a treatment w as continued throughout the follicular phase. Main Outcome Measure(s): Ovarian stimulation patterns and IVF outcome. Result(s): A significantly higher cancellation rate was noted in the study group than in the controls (22.5% versus 5%, respectively). The new and con trol regimens resulted in similar stimulation characteristics and clinical pregnancy rates (11% versus 10.3%, respectively). In 13 patients with a bas al FSH level that was not persistently high, the new regimen resulted in a significantly higher number of retrieved oocytes compared with the standard protocol (7.6 +/- 1.03 versus 4.0 +/- 0.68, respectively). Conclusion(s): Whereas for most low responders, the new COH regimen offers no further advantage, future prospective studies may demonstrate whether it can confer a benefit fur a subset of patients with a basal FSH level that is not persistently high. (Fertil Steril(R) 1999;72:406-11. (C) 1999 by Ame rican Society for Reproductive Medicine.)