Microdose follicular flare: a viable alternative for normal-responding patients undergoing in vitro fertilization?

Abstract

Objective: To compare cycle outcomes among normal-responding patients ≤30 years old receiving microdose follicular flare (MDF) and long-luteal agonist (LL). Design: Retrospective cohort study. Setting: Military-based assisted reproductive technology (ART) center. Patient(s): First autologous ART cycles among 499 women ≤30 years old from January 1999 to December 2005. Intervention(s): After oral contraceptive pill (OCP) administration before cycle start, patients were nonrandomly assigned to either LL or MDF for LH surge suppression. Patients in the LL group received 1 mg/day leuprolide acetate (LA) on cycle day 21, which was reduced to 0.25 mg/day 10-14 days later. Patients in the MDF group received LA (40 μg twice a day) beginning 3 days after discontinuing OCPs. Both groups received a combination of hMG and recombinant FSH. Main Outcome Measure(s): Primary outcomes were implantation, clinical pregnancy, and live-birth rates; in-cycle variables included peak E2, oocytes retrieved, oocyte maturity, and fertilization rate. Result(s): Multivariable models controlling for confounding by treatment indication found no significant differences between groups in implantation (MDF, 36%; LL, 38%), clinical pregnancy (MDF, 53%; LL, 56%), and live-birth rates (MDF, 47%; LL, 50%). No differences were observed in peak E2, oocytes retrieved, oocyte maturity, fertilization rate, or embryos transferred. Conclusion(s): MDF use among normal-responding ART patients produced no differences in cycle outcome when compared with LL. Therefore, MDF may be a viable alternative for normal-responding patients. © 2009 American Society for Reproductive Medicine.