Clinical Effects of a Microdose GnRH Agonist Flare Regimen Administered to Poor Responders Undergoing ART Cycles
The microdose GnRH agonist (GnRH-a) flare protocol may have a particular value for previously poor responders in whom it has been observed to stimulate dramatic increases in serum FSH. The Purpose of this study was to determine the effects of microdose GnRH-a in poor responders. This is a clinical trial with before and after design. This study was done in Research and Clinical Center for Infertility (Shahid Sadoughi University, Yazd, Iran) and Madar Hospital, Yazd, Iran. In this study, 61 poor responders volunteered for in vitro fertilization (IVF) or intracytoplacmic sperm injection (ICSI). The volunteers were divided into two age groups (group A, 20 - 34; group B, 35 - 40) and received low dose oral contraceptive pills for 21 days, then 40µg of subcutaneous buserelin 2 times/day from day 3 of the cycle and human menopausal gonadotropin (hMG) 3 ampoules/day from day 5. Main Outcome measures were number of follicles, oocytes and embryos, and pregnancy rate (PR). These measures were then compared with those of the previous cycle. There were significant differences in all parameters (P < 0.05). Pregnancy occurred in 3 women (5%). There was no significant difference in number of follicles, oocytes and embryo between two age groups (P > 0.05). Use of microdose GnRH-a plus HMG for controlled ovarian hyperstimulation in IVF or ICSI cycles can lead to formation of more follicles, oocyte and embryo in poor responders.
Porter RN, Smith W, Craft IL, Abdulwahid NA, Jacobs HS. Induction of ovulation for in-vitro fertilization using buserelin and gonadotropins. Lancet 1984; 2(8414): 1284-5.
Droesch K, Muasher SJ, Brzyski RG, Jones GS, Simonetti S, Liu HC, et al. Value of suppression with a gonadotropinreleasing hormone agonist prior to gonadotropin stimulation for in vitro fertilization. Fertil Steril 1989; 51(2): 292-7.
Hughes EG, Fedorkow DM, Daya S, Sagle MA, Van de Koppel P, Collins JA. The routine use of gonadotropinreleasing hormone agonists prior to in vitro fertilization and gamete intrafallopian transfer: a meta-analysis of randomized controlled trials. Fertil Steril 1992; 58(5): 888-96.
Leondires MP, Escalpes M, Segars JH, Scott RT Jr, Miller BT. Microdose follicular phase gonadotropin-releasing hormone agonist (GnRH-a) compared with luteal phase GnRH-a for ovarian stimulation at in vitro fertilization. Fertil Steril 1999; 72(6): 1018-23.
Filicori M, Flamigni C, Cognigni G, Dellai P, Arnone R, Falbo A, et al. Comparison of the suppressive capacity of different depot gonadotropin-releasing hormone analogs in women. J Clin Endocrinol Metab 1993; 77(1): 130-3.
Balasch J, Jové IC, Moreno V, Civico S, Puerto B, Vanrell JA. The comparison of two gonadotropin-releasing hormone agonists in an in vitro fertilization program. Fertil Steril 1992; 58(5): 991-4.
Garcia JE, Padilla SL, Bayati J, Baramki TA. Follicular phase gonadotropin-releasing hormone agonist and human gonadotropins: a better alternative for ovulation induction in in vitro fertilization. Fertil Steril 1990; 53(2): 302-5.
Tan SL, Kingsland C, Campbell S, Mills C, Bradfield J, Alexander N, et al. The long protocol of administration of gonadotropin-releasing hormone agonist is superior to the short protocol for ovarian stimulation for in vitro fertilization. Fertil Steril 1992; 57(4): 810-4.
Acharya U, Small J, Randall J, Hamilton M, Templeton A.Prospective study of short and long regimens of gonadotropin- releasing hormone agonist in in vitro fertilization program. Fertil Steril 1992; 57(4): 815-8.
Surrey ES, Schoolcraft WB. Evaluating strategies for improving ovarian response of the poor responder undergoingassisted reproductive techniques. Fertil Steril 2000; 73(4): 667-76.
Scott RT, Navot D. Enhancement of ovarian responsiveness with microdoses of gonadotropin-releasing hormone agonist during ovulation induction for in vitro fertilization. Fertil Steril 1994; 61(5): 880-5.
Jansen CAM, Tucker KE. Microdose GnRH for the stimulation of low responders. In: Allahbadia GN, Basuray Das R, editors. The Art and Science of Assisted Reproductive Techniques (ART). London: Taylor and Francis; 2003. p. 73-6.
Kanzepolsky LS, de Fried EP. A randomized, prospective study of microdose leuprolide versus oocyte donation in poor response patients. Fertil Steril. 2003; 80(3):192.
Detti L, Williams DB, Robins JC, Maxwell RA, Thomas MA. A comparison of three downregulation approaches for poor responders undergoing in vitro fertilization. Fertil Steril 2005; 84(5): 1401-5.
Schoolcraft W, Schlenker T, Gee M, Stevens J, Wagley L. Improved controlled ovarian hyperstimulation in poor responder in vitro fertilization patients with a microdose follicle- stimulating hormone flare, growth hormone protocol. Fertil Steril 1997; 67(1): 93-7.
Sharara FI, McClamrock HD. A modified microdose GnRHa/Gonadotrophin protocol for ovarian stimulation in IVF: experience in 102 cycles. Middle East Fertil Soc J 2000; 5: 204-8.
Surrey ES, Bower J, Hill DM, Ramsey J, Surrey MW. Clinical and endocrine effects of a microdose GnRH agonistflare regimen administered to poor responders who are undergoing in vitro fertilization. Fertil Steril 1998; 69(3): 419-24.
Silverberg K, Ormand R, Hansard L. Ultra- Low dose Lupron flare shows promising results for poor IVF responders. American Society for Reproductive Medicine (ASRM) Conference. Canada: Toronto, Ontario, 1999.
Weissman A, Shoham Z. GnRH and its agonistic analogues: basic knowledge. In: Shoham Z, Howles CM, Jacobs HS, editors. Female Infertility Therapy: Current Practice. London: Martin Dunitz Ltd; 1999. p. 155-66.
Akman MA, Erden HF, Tosun SB, Bayazit N, Aksoy E, Bahceci M. Comparison of agonistic flare-up-protocol and antagonistic multiple dose protocol in ovarian stimulation of poor responders: results of a prospective randomized trial. Hum Reprod 2001; 16(5): 868-70.
Sharara FI, McClamrock HD. Use of microdose GnRH agonist protocol in women with low ovarian volumes undergoing IVF. Hum Reprod 2001; 16(3): 500-3.
Copyright (c) Acta Medica Iranica
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.