Outcome of Two Protocols in Poor Responders in Assisted Reproductive Technology (ART) Cycle

Comparison of Micro Dose Gonadotropin-Releasing Hormone (GnRH) Agonist Flare up & Flare Protocol in Poor Responders in Assisted Reproductive Technology (ART) Cycle

About 9 to 24 % of women undergoing in vitro fertilization (IVF) treatment respond poorly to the usual gonadotrophin stimulation protocol applied. Several induction ovulation treatments have been suggested for increasing pregnancy rate. In this study, the investigators will compare the outcome of Microflare protocol and Flare up regimen in poor responders.

In this randomized clinical trial study, a total of 200 infertile women with poor ovarian response who undergo IVF / ICSI treatment cycle at Royan Institute will enroll in this study and will randomly be divided into two groups of 100 patients. This study has been approved by Royan ethics committee and written consent will be obtained from each patient. The patients will be randomized to one of two groups of Flare Up or Microdose GnRh agonist flare up. Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Estradiol, will be evaluated on day 2 or 3 and when follicle size become >14. 2 weeks after embryo transfer, the patients will be tested for serum β-hCG for assessing the pregnancy. The clinical pregnancy will be clarified by the number of women with gestational sacs on transvaginal sonography at 4-6 weeks of gestation. In the calculation of implantation, the number of gestational sacs will be considered.

Inclusion Criteria: Poor responders (Presence of at least two of following items is necessary for inclusion to the study) History of Cycle Cancellation History of oocyte number 3 (in previous cycle) History of Number of antral follicle < 5 in previous cycle Age≥38 FSH>12 on day 2 or 3 Ovarian Volume 3 cm3 Exclusion Criteria: Male factor (azospermi) Myoma ≥6cm One way ovary Tumor or cyst >13mm Age >42

1- Endocrinology and Female Infertility Department, Reproductive Medicine Research Centre, Royan Institute, ACECR

Ghaffari F, Jahangiri N, Madani T, Khodabakhshi S, Chehrazi M. Randomized controlled trial of gonadotropin-releasing hormone agonist microdose flare-up versus flare-up among poor responders undergoing intracytoplasmic sperm injection. Int J Gynaecol Obstet. 2020 Jan;148(1):59-64. doi: 10.1002/ijgo.12988. Epub 2019 Oct 18.