Stimulation of the young poor responder: comparison of the luteal estradiol/gonadotropin-releasing hormone antagonist priming protocol versus oral contraceptive microdose leuprolide

Objective: To evaluate in vitro fertilization (IVF) cycle outcomes in young poor responders treated with a luteal estradiol/gonadotropin-releasing hormone antagonist (E-2/ANT) protocol versus an oral contraceptive pill microdose leuprolide protocol (OCP-MDL). Design: Retrospective cohort. Setting: Academic practice. Patient(s): Poor responders: 186 women, aged <35 years undergoing IVF with either E-2/ANT or OCP-MDL protocols. Intervention(s): None. Main Outcome Measure(s): Clinical pregnancies, oocytes retrieved, cancellation rate. Result(s): Patients in the E-2/ANT group had a greater gonadotropin requirement (71.9 +/- 22.2 vs. 57.6 +/- 25.7) and lower E-2 level (1,178.6 +/- 668 vs. 1,627 +/- 889), yet achieved similar numbers of oocytes retrieved and fertilized, and a greater number of embryos transferred (2.3 +/- 0.9 vs. 2.0 +/- 1.1) with a better mean grade (2.14 +/-.06 vs. 2.7 +/- 1.8) compared with the OCP/MDL group. The E2/ANT group exhibited a trend toward improved implantation rates (30.5% vs. 21.1%) and ongoing pregnancy rates per started cycle: 44 out of 117 (37%) versus 17 out of 69 (25%). Conclusion(s): Poor responders aged <35 years may be treated with the aggressive E-2/ANT protocol to improve cycle outcomes. Both protocols remain viable options for this group. Adequately powered, randomized clinical comparison appears justified. (Fertil Steril (R) 2011;95:592-5. (C) 2011 by American Society for Reproductive Medicine.)