Comparison of microdose GnRH agonist protocol with GnRH antagonist / letrazole protocol in patients with poor ovarian response

Objective: To compare microdose GnRH agonist (MDL) protocol with GnRH antagonist/letrazole (AL) protocol in patients with poor ovarian response.Design: Randomised clinical trial.Setting: Kocaeli University Assisted Reproductive CentrePatients: Fifty-five patients with the diagnosis of poor ovarian response (POR) were randomized and performed either MDL or AL protocol.Interventions: POR was diagnosed according to ESHRE Bologna criteria in case of presence of 2 out of 3 criteria. In the MDL group (n=27), 40 mu g/0.2 cc subcutaneous leuprolid acetate was given two times a day starting on the first day of menstrual cycle. On the second day of the cycle, gonadotrophin stimulation was started at 450-600 IU and/or 150 IU human menopausal gonadotrophin (hMG) along with leuprolid. In the AL group (n=28), 5 mg letrazole was given for 5 days starting on the second day of the spontaneous cycle and after the 5th day of the cycle, 450-600 IU and/or 150 IU hMG was given.Main Outcome Measures: To compare the outcomes of MDL protocol with AL protocol in patients with poor ovarian response.Results: Stimulation days, total gonadotrophin dose ( IU), peak E2 (pg/ml) levels, and endometrial thickness were found to be statistically significantly lower in the AL group. While no cases of cycle cancellation was detected in the MDL group, statistically significantly higher rates of cycle cancellation (%42.8, p<0.001) was detected in the AL group. No statistically significant differences were detected in total oocyte numbers (3.7 +/- 2.9 vs 2.7 +/- 2.2), number of transferred embryos (1.4 +/- 0.5 vs 1.4 +/- 1.9) and pregnancy rates (3 vs 2) in between the groups.Comment: Although AL protocol is not superior to MDL protocol in poor ovarian response patients, it may be used as an alternative protocol.