[Short vs long agonist protocols in poor responders undergoing IVF]

Area of Science:

• Reproductive endocrinology and infertility treatments.
• Assisted reproductive technologies (ART).

Background:

• Ovarian response to stimulation protocols is crucial for successful in vitro fertilization (IVF).
• Identifying optimal stimulation protocols for poor responders remains a challenge in reproductive medicine.

Purpose of the Study:

• To compare the efficacy of the long agonist protocol versus the short agonist protocol in poor responders undergoing IVF.
• To evaluate stimulation results, laboratory parameters, and final IVF outcomes between the two protocols.

Main Methods:

• A retrospective analytical study of 92 IVF cycles in 65 poor responder patients between January 2006 and December 2007.
• Inclusion criteria included age >38 years with FSH >9.5 IU/ml, antral follicle count <5, or previous poor response.
• Exclusion criteria were PCOS or a single ovary.

Main Results:

• The short agonist protocol group showed a significantly higher estradiol level on the day of trigger (p=0.034).
• Fewer gonadotropins were consumed in the short protocol group (p=0.01), with a significantly lower cycle cancellation rate (9.09% vs 18.75%).
• The short protocol resulted in significantly more oocytes retrieved (7.64 vs 4.55, P<0.001) and higher quality embryos (2.61 Grade 1 embryos, p<0.001).

Conclusions:

• The short agonist protocol is better suited for poor responders undergoing IVF.
• Standard long agonist protocols are not recommended for poor responders.
• Modified long protocols (microdose flare-up and degressed microdose) may offer comparable results to the short protocol.