GnRHa flare and IVF pregnancy rates

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization (IVF)

Background:

• Gonadotropin-releasing hormone (GnRH) agonist flare protocols are used for IVF in poor responders.
• Controversy exists regarding their efficacy in improving pregnancy rates.

Purpose of the Study:

• To compare the efficacy of a GnRH agonist flare protocol versus a long suppression protocol in IVF poor responders.
• To evaluate pregnancy rates and ovarian response parameters between the two protocols.

Main Methods:

• Retrospective comparison of 73 poor responders treated with GnRH agonist flare protocol against 128 age-matched poor responders treated with long suppression protocol.
• Poor responders defined by peak E2 < 1000 pg/ml and/or < 5 mature follicles (>15 mm) on hCG day.
• Statistical analysis using Student's t-test and chi-squared test.

Main Results:

• The flare protocol group showed significantly higher peak E2 levels (1647 vs. 720 mIU/ml) and more mature follicles (5.8 vs. 4.0) compared to the long suppression group.
• Pregnancy rates were comparable between the flare protocol (30%) and the long suppression protocol (37%).

Conclusions:

• GnRH agonist flare protocol increases peak E2 levels and the number of mature follicles in IVF poor responders.
• However, it does not lead to significantly better pregnancy rates compared to the long GnRH agonist suppression protocol.
• Successful outcomes in both groups may be attributed to high-dose gonadotropin treatment.