Beneficial effects of a higher starting dose of gonadotrophins in some poor responders

We performed a prospective study to examine the benefits of higher starting dose in poor responders to gonadotrophins. One hundred eighty-seven normal responders (group 1), 40 poor responders (group 2), and 25 poor responders from group 2 (group 3) were included in the study. Groups 1 and 2 received 300 IU of metrodin HP for 5 days followed by 150 IU of recombinant human follicle-stimulating hormone (rhFSH) until the day before hCG. Group 3 received 450 IU of metrodin followed by rhFSH as in groups 1 and 2. Number of oocytes retrieved, rates of fertilization, implantation, pregnancy, and miscarriage rates were compared between the groups. There were no differences between the three groups in the fertilization rate. The higher dose of metrodin (450 IU) for 5 days increased the number of oocytes retrieved in some patients belonging to group 3 and significantly increased (P < 0.01) the implantation and pregnancy rates compared with group 2 patients. However, the higher dose of metrodin also increased miscarriage rates significantly in group 3 compared with groups 1 and 2 (P < 0.04). In some poor responders, a higher starting dose of gonadotrophin resulted in more oocytes retrieved and led to higher implantation and pregnancy rates and a higher miscarriage rate.