Comparison of GnRH-Agonist Microdose Flare-up Protocol and Flexible Multiple Dose Antagonistic Protocol in Poor Responder Patients Undergoing Intracytoplasmic Sperm Injection Cycle

Objective: To compare the efficacy of the microdose flare-up and multiple-dose antagonist protocols for poor responder patients in intracytoplasmic sperm injection (ICSI). Materials and Methods: Of 1927 patients who had undergone ICSI cycles in the Erciyes University Department of Assisted Reproduction between 2005- 2012, 216 poor responder patients were included in the study. There were 69 patients in the microdose flare-up group, and 147 patients- in the antagonist group. The groups were compared in terms of cycle parameters, and clinical pregnancy rate (CPR). Results: The groups were identical with regard to demographic parameters, with the exception of duration of infertility, which was significantly longer in the microdose group (12.10±5.87 years 9.32±5.57 years). No significant difference was found between groups in terms of gonadotropin- doses, E2 levels, endometrial thickness and pattern. Total and mature oocyte numbers were higher in the antagonist group (3.97±3.66 vs 5.41±4.65, and, 2.88±3.15 vs 4.27±3.78, respectively). CPRs were comparable between groups (%10.1 vs %19). Conclusion: Microdose GnRH-a flare-up and multiple dose GnRH antagonist protocols have similar CPR in poor responder patients undergoing ICSI cycles. In view of its lower cost and yielding higher total and mature oocytes, GnRH antagonist could be preferred to the microdose flare protocol.