A Comparison of the Use of the Microdose Flare-Up Ovarian
Hyperstimulation Protocol in IVF Patients with Diminished Ovarian
Reserve and in Patients with Previous IVF Failure with Long Protocol
Regimens of GnRh Agonist

Mustafa UĞUR, Murat EKİN, Ayça IŞIK
Ankara-Turkey

OBJECTİVE: Microdose GnRH agonists flare-up protocol is generally reserved for patients with previous long GnRH agonist protocol failure. This study evaluates wether patients in their initial attempt of IVF with diminished ovarian reserve would also benefit of such a regimen.
MATERİAL AND METHODS: In this prospective study a total 27 patients who underwent an IVF cycle with microdose GnRH agonists flare-up protocol were analysed. Of these; 12 patients ( group I) had not responded well previously to controlled ovarian hyperstimulation with long term downregulation with GnRH agonist. (long protocol) and 15 patients ( group II) in their initial IVF cycle with reduced ovarian reserve was defined according to number of antral follicles, total ovarian volume by ultrasonography, high levels of day 3 FSH or age >40. The average age of the patients were 37.2±3.8 years (range 30-42) and 35.9±5.8 (range 22-42) in group I and group II respectively. All patients received oral contraceptive pills until cycle day 0 followed by 20 micrograms of leuprolide acetate every 12 hours with addition of gonodotropins on cycle day 5.
RESULTS: The averege day 3 FSH levels of the patients on the flare-up protocol cycles were 10.2±3.5 in group I and 10.1±2.5 in groupII. (P>0.05) Cancelation of the cycle due to inadequate response were 2 of 12 patients (16.6%) in group I and 3 of 15 patients (20%) in group II respectively (P>0.05). The average number of oocytes obtained was 4.5±4.1 and 3.5±2.1 in group I and group II respectively (P>0.05). There was 1 pregnancy in group I and 2 pregnancies in group II respectively.
CONCLUSİON: The microdose GnRH agonist flare-up protocol after an unsuccesful long luteal phase protocol can decrease the cancelation rate. Microdose flare-up protocol can also be used in patients with diminished ovarian reserve in the first IVF attempt. However, pregnancy rate is still not improved in poor responders.
(Gynecol Obstet Reprod Med 2005; 11:37-39)

Key Words: Flare-up, Poor responder, IVF