Effect of Antagonist Start Day on Cycle Outcomes in Poor Responders.

BACKGROUND

Despite the great advances in Assisted Reproductive Technologies (ART), management of poor responders has remained a great challenge. Gonadotropin releasing hormone antagonist (GnRH-ant) has been offered as a patient friendly protocol. In the literature, conflicting data exists about the effect of the GnRH-ant starting day on cycle outcomes.

AIM

The aim of this study is to evaluate the effect of GnRH-ant starting day on cycle outcomes of patients with poor ovarian response defined by Bologna criteria.

SETTING AND DESIGN

This retrospective cohort study was conducted at an ART clinic of a tertiary hospital.

MATERIALS AND METHODS

A total of 361 cycles using flexible GnRH-ant, 195 in Group A (GnRH-ant administered before day 6 of stimulation) and 166 cycles in Group B (GnRH-ant started on or after day 6), were selected retrospectively for the study.

STATISTICAL ANALYSIS

Statistical analysis of data was carried out using using IBM SPSS Statistics Software (20.0, SPSS Inc., Chicago, IL, USA). Independent samples t-test and Mann-Whitney U test were used to analyze the variables.

RESULTS

Total antral follicle count was significantly higher in Group A compared to Group B ( = 0.009). Duration of stimulation was significantly shorter ( < 0.01) and total dose of gonadotropin used was lower in Group A when compared to Group B ( < 0.01). While higher number of oocytes was retrieved from Group A ( = 0.037), no between-group differences were observed in number of mature oocytes, fertilized oocytes, clinical pregnancy rate or ongoing pregnancy rate (OPR) per embryo transfer ( > 0.05).

CONCLUSION

Early GnRH-ant start may point out a favourable response to ovarian stimulation in poor responders. However, clinical or OPRs were not different from the late GnRH-ant start group.