Recombinant follicle stimulating hormone is effective in poor responders to highly purified follicle stimulating hormone

Ovarian stimulation in cases of poor ovarian responsiveness is an important challenge in in-vitro fertilization (IVF) programmes. Despite improvements in oocyte number and quality, an ideal ovarian stimulation strategy has ye t to be defined. Here, the results of ovarian stimulation with recombinant follicle stimulating hormone (rFSH) in 28 poor responders to highly purifie d FSH (FSH-HP) with high basal concentrations of FSH are reported. The prot ocols used on the FSH-HP and rFSH cycles were identical with the sole excep tion of the FSH preparation: triptorelin 0.1 mg/day (gonadotrophin-releasin g hormone, GnRH-agonist short protocol) and the starting FSH dose of 300 IU /day were administered from day 2 of the menstrual cycle. Ovarian outcome w as classified as 'normal','intermediate' and 'poor', depending on the numbe r of mature oocytes retrieved and the peak serum oestradiol concentration, Nine of the 28 subjects had an intermediate ovarian response to re-stimulat ion with rFSH, In the 26 patients who received human chorionic gonadotrophi n on both cycles? re-stimulation resulted in a significant increase (P < 0. 05) in the mean number of mature oocytes (2.4 +/- 1.4 versus 1.7 +/- 0.8), mean peak oestradiol concentration (606 +/- 252 versus 443 +/- 32 pg/ml) an d fertilization rate (73.0 versus 53.3%). Four pregnancies were achieved. I t is concluded that rFSH in a GnRH-agonist short protocol improves the ovar ian outcome in poor responders to FSH-HP with high basal concentrations of FSH.