The Efficacy of GnRH Antagonist Protocol in Controlled Ovarian Hyperstimulation of Poor Responders

Lee, Eun Sil; Kim, Dong Ho; Bae, Do Hwan; Lee, Sang Hoon

Abstract

OBJECTIVE
This study was performed to estimate the efficacy of GnRH antagonist (cetrorelix) protocol in poor responders comparing with GnRH agonist protocol.
METHODS
This study included 43 cycles of 38 patients who were defined as poor responders on previous consecutive two and more superovulation cycles. The study group consisted of 20 cycles of 18 poor responders treated with cetrorelix according to single dose protocol with clomiphene citrate, who were compared with 23 cycles of 20 poor responders (control group) stimulated according to GnRH agonist flare up protocol.
RESULTS
Although the use of GnRH antagonist with clomiphene citrate gave a pregnancy rate of 15% which was in the range expected for patients with poor response, the study group had higher E2 level on hCG day (1246.5 +/- 89.4 vs 644.7 +/- 34.8 pg/ml) with higher number of mature oocytes (7.8 +/- 1.3 vs 4.3 +/- 0.5), and length of stimulation (15.5 +/- 1.4 vs 19.4 +/- 2.6 days), number of hMG ampules administered (19.4 +/- 3.2 vs 45.4 +/- 5.9 ampules), and cancellation rate (35.0 vs 47.8%) were significantly lower in the cetrorelix group. Although it was not statistically significant between two groups, the pregnancy rate (15 vs 8.6%) showed higher tendency in cetrorelix group.
CONCLUSION
The use of GnRH antagonist cetrorelix ended with significantly more mature oocytes, less ampules of gonadotropin, shorter duration of stimulation and lower cancellation rate in this study. So the GnRH antagonist protocol may be an alternative protocol for the treatment of poor responders.