Gonadotropin stimulation following GnRH-a priming for poor responders in in vitro fertilization-embryo transfer programs

The effect of gonadotropin-releasing hormone agonist (GnRH-a) administratio n before gonadotropin super-ovulation on the stimulation characteristics of poor responder patients was assessed in an in vitro fertilization (IVF) pr ogram. Thirty consecutive patients who had exhibited low ovarian response (fewer t han four retrieved oocytes) in at least two previous IVF cycles (control cy cles, n = 60), were eligible for the study. GnRH-a (nafarelin) was administ ered daily for 7-10 days from the mid-luteal phase of the previous cycle un til the first day of menstruation. Menotropin treatment was commenced on cy cle day 3 (with no additional GnRH-a) (study cycles, n = 39). A significantly higher number of oocytes was retrieved (p < 0.0002) and a h igher number of embryos transferred (p < 0.003) in the study cycles than in the control cycles. No cases of premature luteinizing hormone surge were r ecorded. Pregnancy rates per embryo transfer and per cycle were 10.4% and 7 .7% for the study cycles and 2.8% and 1.6% for the control cycles, respecti vely. GnRH-a, administered prior to gonadotropin treatment, should be an addition al option of ovulation induction protocol for poor responders in IVF progra ms.