Effect of antagonist start day on cycle outcomes in poor responders

Abstract

Background: Despite the great advances in Assisted Reproductive Technologies (ART), management of poor responders has remained a great challenge. Gonadotropin releasing hormone antagonist (GnRH-Ant) has been offered as a patient friendly protocol. In the literature, conflicting data exists about the effect of the GnRH-Ant starting day on cycle outcomes. Aim: The aim of this study is to evaluate the effect of GnRH-Ant starting day on cycle outcomes of patients with poor ovarian response defined by Bologna criteria. Setting and Design: This retrospective cohort study was conducted at an ART clinic of a tertiary hospital. Materials and Methods: A total of 361 cycles using flexible GnRH-Ant, 195 in Group A (GnRH-Ant administered before day 6 of stimulation) and 166 cycles in Group B (GnRH-Ant started on or after day 6), were selected retrospectively for the study. Statistical analysis: Statistical analysis of data was carried out using using IBM SPSS Statistics Software (20.0, SPSS Inc., Chicago, IL, USA). Independent samples t-Test and Mann-Whitney U test were used to analyze the variables. Results: Total antral follicle count was significantly higher in Group A compared to Group B (P = 0.009). Duration of stimulation was significantly shorter (P < 0.01) and total dose of gonadotropin used was lower in Group A when compared to Group B (P < 0.01). While higher number of oocytes was retrieved from Group A (P = 0.037), no between-group differences were observed in number of mature oocytes, fertilized oocytes, clinical pregnancy rate or ongoing pregnancy rate (OPR) per embryo transfer (P > 0.05). Conclusion: Early GnRH-Ant start may point out a favourable response to ovarian stimulation in poor responders. However, clinical or OPRs were not different from the late GnRH-Ant start group.