IVF protocol for patients with poor ovarian response

This study investigated a combined Stop GnRH agonist and multiple-dose GnRH antagonist protocol for patients with a previous poor ovarian response (POR). It found that this protocol may lead to a higher number of oocytes collected.

Patients with POR produce few oocytes (eggs) in response to ovarian stimulation (OS) medications. POR makes infertility treatment using in vitro fertilization (IVF) more difficult. One goal of IVF researchers is to modify the IVF protocol for patients with POR, including the method used to reduce the patient’s own luteinizing hormone (LH) prior to OS. This step is necessary to prevent an early ovulation before the egg collection.

Two methods are commonly used. These are GnRH agonist and GnRH antagonist protocols. The GnRH agonist protocol takes a longer period of time but may improve the body’s own level of follicle-stimulating hormone (FSH). FSH promotes ovarian follicle development. GnRH antagonist 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 GnRH agonist as the trigger injection before egg collection.

The Stop GnRH agonist and multiple-dose GnRH antagonist combined protocol uses both medications. Initially, a GnRH agonist is given during the end (luteal phase) of the woman’s previous menstrual cycle and stoped when the period begins. Then, a GnRH antagonist is given during the OS egg collection cycle. The combined protocol was designed to allow the advantages of both medications. However, it is not known whether the combined protocol leads to better outcomes for patients with POR.

This study included records from 30 patients with POR. All patients underwent combined protocol IVF or intracytoplasmic sperm injection (ISCI). All subjects had undergone a previous IVF cycle using GnRH antagonist within the previous three months which had a low yield of up to three oocytes.

The combined protocol cycle required significantly higher doses of gonadotropin hormones than the previous GnRH antagonist cycle. However, significantly more oocytes were collected in the combined protocol cycles (3.93 vs. 1.33). There were also significantly more top-quality embryos per patient (1.6 vs. 0.53). Fewer embryo transfers were canceled in the combined protocol cycle due to a lack of an embryo (20.0% vs. 56.7%).

Due to the patient selection process, no patients had conceived during the previous GnRH antagonist cycle. 5 patients (16.6%) became pregnant during the combined protocol cycle.

This study found that a combined Stop GnRH agonist and GnRH antagonist IVF protocol may lead to more oocytes than GnRH antagonist IVF for patients with POR.

Using a previous unsuccessful cycle as a comparison group is a biased study design. This is because patients who had a successful GnRH antagonist IVF cycle were excluded from the study. This is a small initial study, and more studies are needed.