Long gonadotropin releasing hormone agonist versus short agonist versus antagonist regimens in poor responders undergoing IVF a randomized controlled trial

Capsule:
The long gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist regimens offer suitable choices for women with poor ovarian response undergoing IVF. The short GnRH agonist regimen is the least effective for poor responders.

Authors:
Sesh Kamal Sunkara, M.D., M.R.C.O.G., Arri Coomarasamy, M.D., M.R.C.O.G., Raef Faris, M.R.C.O.G., Peter Braude, Ph.D., F.R.C.O.G., Yacoub Khalaf, F.R.C.O.G.

Volume 101, Issue 1, Pages 147-153, January 2014

Abstract:

Objective:
To compare the efficacy of the long GnRH agonist vs. the short GnRH agonist vs. the GnRH antagonist regimens in poor responders undergoing IVF.

Design:
Randomized controlled trial.

Setting:
Tertiary referral fertility units.

Patient(s):
Women with previous poor ovarian response undergoing IVF.

Intervention(s):
One hundred eleven women were randomized to the long GnRH agonist, short agonist, and antagonist regimens.

Main Outcome Measure(s):
The primary outcome was the number of oocytes retrieved. Secondary outcome measures were gonadotropin consumption, duration of stimulation, cycle cancellation rate, mature oocytes retrieved, fertilization rate, cycles reaching ET, and clinical and ongoing pregnancy rates.

Result(s):
Number of oocytes retrieved was significantly higher with long GnRH agonist compared with the short agonist regimen (4.42 ± 3.06 vs. 2.71 ± 1.60), while there was no significant difference between long agonist and antagonist regimens (4.42 ± 3.06 vs. 3.30 ± 2.91). Duration of stimulation and total gonadotropin dose were significantly higher with long agonist compared with short agonist and antagonist regimens. The ongoing pregnancy rate was 8.1% with long and short agonist regimens and 16.2% with the antagonist regimen.

Conclusion(s):
Long GnRH agonist and antagonist regimens offer a suitable choice for poor responders, whereas the short agonist regimen may be less effective because of fewer eggs retrieved.

  • Lauren Johnson

    I congratulate the authors on publication of this randomized trial comparing the
    number of oocytes retrieved among poor responders randomized to one of three
    stimulation protocols. While there were small differences in oocyte yield
    between the long and short GnRH agonist protocols, none of the protocols appeared
    to be clearly superior. This paper highlights the need for novel treatment
    strategies for poor responders.

    I do have a question for the authors: I was surprised that a flare protocol was
    not included as one of the intervention arms. Could you comment on the decision
    not to include a flare protocol in the trial?

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