Mini-Dose Long Gonadotropin-Releasing Hormone (GnRH) Agonist Versus Agonist Flare Stimulation Protocol for in Vitro Fertilization Poor Responders

Aim of the Work: To compare 2 stimulation protocols, mini-dose long gonadotropin releasing hormone (GnRH) agonist versus agonist flare for in vitro fertilization poor responders. Design: Prospective comparative nonrandomized clinical trial. Setting: Kasr Al Ainy IVF center, Cairo University Teaching Hospital from February 2013 to July 2013 on 50 women undergoing IVF/ICSI fulfilling the criteria of poor responders. Material and Methods: Patients were allocated into 2 groups, group 1 (n=25) received mini-dose long agonist and group 2 (n=25) received agonist flare protocol. Main Outcome: Number of oocytes retrieved (primary outcome), duration of stimulation (days), peak E2 level on the day of hCG injection, number of fertilized oocytes, number of transferred embryos and pregnancy rate/cycle. Results: Both groups were comparable regarding age, body mass index and duration of infertility (years). The difference in basal FSH, duration of stimulation (days) doesn't reach statistical significance (p-value 0.833 and 0.373 respectively). There was high statistical difference between both groups regarding peak E2 on day of hCG injection, number of oocytes retrieved, number of fertilized oocytes, number of transferred embryos; which is higher in mini-dose agonist group (p-value 0.000). Pregnancy rate/cycle was higher in mini-dose agonist group (9/25 vs. 6/25) however this difference doesn't reach statistical significance (p-value 0.355) which may be attributed to small sample size or advanced maternal age. Conclusion: Mini-dose long GnRHa stimulation protocol appears to be more beneficial for poor responders than GnRHa agonist flare.