Antagonist/letrozole protocol versus microdose flare-up protocol in poor responders: a randomized study

Document Type : Original Article

Author

Department of Obstetrics and Gynecology, Zagazig University School of Medicine, Zagazig, Egypt

Abstract

Objective: To compare the efficacy of gonadotropin-releasing hormone (GnRH) antagonist/
letrozole (AL) and micro-dose flare-up (MF) protocols on cycle parameters and clinical
outcomes in poor responders.
Patients & methods: A randomized prospective study comprised of 150 infertile women
undergoing controlled ovarian stimulation (COS) and intracytoplasmic sperm injection
(ICSI) and classified as past or potential poor responders based on specific criteria. Participants were prospectively randomized to receive AL protocol (group I, n=75) or MF protocol
(group II, n=75). Clinical pregnancy was the primary outcome. Cycle cancellation rate,
dose of gonadotropin used, serum E2 levels, number of retrieved oocytes, fertilization rate,
and embryo quality were secondary outcomes
Result(s): Patient characteristics were similar between the two protocol groups. There were
no significant differences in mean age, number of oocytes, fertilization rates, number of
embryos transferred, or embryo score. Peak E2 levels were lower in the AL group, although
this difference did not reach statistical significance. Clinical pregnancy per started cycle
(33.3% versus 29.3%, P=0.59) and per embryo transfer (36.8% versus 34.4%, p=0.7) were
comparable between AL and MF protocols. Trends toward lower cancellation rates were
noted among AL group, but these did not reach statistical significance.
Conclusion(s): The treatment outcomes of gonadotropin-releasing hormone antagonist/letrozole protocol and the microdose flare-up protocol seem to be similar in poor ovarian
responders undergoing ICSI.

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