Evaluating the effectiveness of different ovarian stimulation protocols for patients with poor ovarian response.

This study evaluated the effectiveness of different ovarian stimulation protocols for patients with poor ovarian response (POR). The data showed that delayed start gonadotropin-releasing hormone (GnRH) antagonist and microdose GnRH agonist were the two most effective regimens for the treatment of these patients.

Many couples with infertility opt to use assisted reproductive techniques (ART). In vitro fertilization (IVF) is an ART in which eggs (oocytes) are collected and fertilized in the lab. Fertilized embryos are then implanted in the uterus (womb). The first step of IVF is to stimulate the ovaries to produce multiple eggs for collection. However, women with POR do not produce many eggs in response to ovarian stimulation.

Two methods are commonly used. These are GnRH agonist (GnRHa) and GnRH antagonist (antGnRH) protocols. GnRH is a chemical produced by the brain to stimulate the ovaries to release other hormones such as follicle-stimulating hormone (FSH). The GnRHa protocol takes a longer period of time but may improve the body’s own level of FSH. FSH promotes ovarian follicle development.

AntGnRH is the other commonly used option to reduce LH levels. This protocol takes a shorter period of time and may be gentler for women with POR. It also allows the option to use GnRHa as the trigger injection before egg collection. The effectiveness of different ovarian stimulation protocols for patients with POR is still not known.

This study analyzed 15 studies and involved 2173 women with POR. Patients were treated with one of the following protocols- delayed start antGnRH, antGnRH, long GnRHa, short GnRHa, microdose GnRHa, and multiple-dose antGnRH.

Delayed start antGnRH had the highest probability to be the best treatment regimen in terms of clinical pregnancy rate per initiating cycle (74.04%), low risk of cycle cancellation (75.3%), number of oocytes retrieved (68.67%), number of metaphase II oocytes (97.98%) and endometrial thickness on triggering day (81.97%).

Microdose GnRHa had the highest probability to be the best treatment regimen for estradiol level on triggering day (99.25%).

There were no significant differences in terms of the number of embryos obtained and the number of transferred embryos between the different ovarian stimulation protocols.

This study concluded that delayed start GnRH antagonist and microdose GnRH agonist were the two most effective regimens for the treatment of patients with poor ovarian response.

The studies analyzed had different criteria for including patients with POR. Also, the doses of GnRHa and antGnRH used were different. Further studies are needed to confirm the findings.