PT  - JOURNAL ARTICLE
AU  - Ashrafi, Mahnaz
AU  - Ashtiani, Saeid K.
AU  - Zafarani, Fatemeh
AU  - Samani, Reza O.
AU  - Eshrati, Babak
TI  - Evaluation of ovulation induction protocols for poor responders undergoing assisted reproduction techniques
DP  - 2005 Apr 01
TA  - Saudi Medical Journal
PG  - 593--596
VI  - 26
IP  - 4
4099  - http://smj.org.sa/content/26/4/593.short
4100  - http://smj.org.sa/content/26/4/593.full
SO  - Saudi Med J2005 Apr 01; 26
AB  - OBJECTIVE: To compare 3 stimulation protocols in poor ovulation responders undergoing in-vitro fertilization (IVF).METHODS: The study was a randomized, prospective clinical trial from June 2003 to July 2004, in Royan Institute, Tehran, Iran. One hundred and fifty-four patients, who had poor responses to ovulation induction in at least one previous IVF attempt, were randomly divided into 3 groups. In the first group, human menopausal gonadotropin (HMG) was administered from day 3 of the cycle at a dose rate of 150IU/day. In the second group, gonadotropin-releasing hormone (GnRH) agonist was started at a dose rate of 800ug/day by nasal spray or 500ug/day subcutaneously in the mid-luteal phase, followed by a standard HMG dose after pituitary down regulation was confirmed. In the third group, clomiphene at a dose rate of 100 mg/day was given from day 3 and HMG from day 6. Our main outcomes were number of mature oocytes, cancellation rate, number of HMG ampoules used and incidence premature luteinizing hormone (LH) surge.RESULTS: There was a high incidence of premature LH surge in all groups except in the GnRH group (p=0.0001) and there were significant differences between groups in HMG requirements (p=0.004). There were no significant differences between groups in number of mature oocytes recovered and cancellation rate.CONCLUSION: Results showed no advantage in the use of GnRH agonist compared to the older regimens of clomiphene plus HMG and HMG alone. The cancellation rate was similar for 3 protocols and HMG requirement was higher with the use of GnRH agonist. The treatment of poor responders in assisted reproductive technologies remains a challenge.