Elsevier

Fertility and Sterility

Volume 81, Issue 6, June 2004, Pages 1572-1577
Fertility and Sterility

Clinical article
A novel protocol of ovulation induction with delayed gonadotropin-releasing hormone antagonist administration combined with high-dose recombinant follicle-stimulating hormone and clomiphene citrate for poor responders and women over 35 years

https://doi.org/10.1016/j.fertnstert.2004.01.022Get rights and content
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Abstract

Objective

To evaluate the efficacy of a novel protocol of ovulation induction for poor responders.

Design

Prospective, controlled, clinical study.

Setting

Research institute's reproductive unit.

Patient(s)

One hundred forty-five infertile women, aged 27–39 years, candidates for assisted reproductive techniques (ART).

Intervention(s)

Before undergoing ART, 85 patients received clomiphene citrate, high-dose recombinant human FSH, and a delayed, multidose GnRH antagonist, whereas 60 patients underwent a standard long protocol.

Main outcome measure(s)

Estradiol levels (pg/mL), cancellation rate, oocyte retrieval, embryo score, and fertilization and pregnancy rates.

Result(s)

Patients undergoing the study protocol obtained lower cancellation rates (4.7% vs. 34%) and higher E2 levels (945.88 ± 173.2 pg/mL vs. 169.55 ± 45.07 pg/mL), oocyte retrieval (5.56 ± 1.13 vs. 3.36 ± 1.3), and pregnancy (22.2% vs. 15.3%) and implantation rates (13.5% vs. 7.6%) compared with those receiving the long protocol. Age negatively correlated with ovarian response in the latter, whereas the ovarian outcome results were comparable in younger (<35 yrs) and older (>35 yrs) women treated with the study protocol.

Conclusion(s)

The proposed protocol of ovulation induction can be usefully administered in poor responders as well as in aged woman, probably because the delayed administration of GnRH antagonist prevents its adverse effects on ovarian paracrine activity and on oocyte maturation.

Keywords

Poor responders
aged women
ovulation induction
clomiphene citrate
GnRH antagonist
ovarian reserve
high-dose recombinant human FSH

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