Comparison of the Microdose Flare Up GnRH Agonist and Antagonist Protocol in Assisted Reproduction with Poor Ovarian Response during Controlled Ovarian Stimulation Cycles

Background: Poor ovarian response presents a significant challenge in artificial reproductive treatment (ART). Poor responders are estimated to comprise approximately 9- 24% of IVF cycles patients. Recently, the development of GnRH antagonist protocol offered another approach for ovarian stimulation by blocking the pituitary receptors. There is evidence that application of GnRH antagonist protocol decreases the duration of ovulatory stimulus and reduce incidence of ovarian hyperstimulation syndrome (OHSS). Objectives: The aim of the current study was to evaluate the effect of the antagonist protocol to the microdose flare up GnRH agonist protocol for poor ovarian responders undergoing IVF/ICSl treatment. Patients and Methods: A total of sixty patients of IVF/ICSI assigned to be poor responders were randomized into two groups; group 1 Thirty patients received GnRH antagonist fixed protocol and group 2 thirty patients received a microdose flare up agonist protocol. Patients characteristics and treatment outcomes were statistically compared between groups. Results: Duration of stimulation was highly significantly lower in the antagonist group than that of the microdose flare up one (antagonist 8.60±1.63 versus microdose flare up 12.06±2.86; p=0.001). Number of ampoules of HMG was highly significantly lower in the antagonist group than that of the micro dose flare up agonist one (antagonist 23.53±7.33 versus micro dose agonist 71.97±9.35; p=0. 001). The number of oocytes retrieved in the antagonist group was not different from microdose flare agonist group (5.14±2.45 vs. 5.11±1.29; p=0.953), and the number of embryos transferred was similar in both groups (2.03±0.08 vs. 2.09 ± 1.05; p=0.674). No significant differences in pregnancy rates were reported. Conclusion: we offer using the "GnRH antagonist" as a patient friendly protocol in ART with poor ovarian response with Immediate mode of action, similar pregnancy rate, time saving, less duration of stimulation and number of ampoules for stimulation than microdose flare up protocol.