[Short vs long agonist protocols in poor responders undergoing IVF]. / Résultats de I'ICSI chex les mauvaises répondeuses : protocole court vs protocole long.

AIM: Compare among poor responders: stimulation results, laboratory parameters and the final IVF results by assessing 2 different stimulation protocols: the long agonist protocol and the short agonist protocol. METHODS: An analytical retrospective study carried out over of period of 2 years: January 2006 and December 2007. During this period, a total of 1192 IVF cycles of ICSI type were performed in 892 patients. INCLUSION CRITERIA: short agonist or antagonist stimulated patients protocols and presenting two of the three following criteria: 1- Patients aged more than 38 years with an FSH plasmatic rate on the 3rd day of the cycle 9.5 UI/ml. 2- Antral follicle count (AFC) 5 for both ovaries. 3- Failure of anterior ovary stimulation: abandonment of cycle or 3 oocytes at data collection in a previous cycle. EXCLUSION CRITERIA: PCOS or single ovary. RESULTS: 65 patients, undergoing 92 attempts of ICSI cycles have been included in this study. Long agonist protocol was performed in 48 cases and Short agonist protocol was performed in 44 cycles. Both groups were comparable as to age (40,09 ± 6, 59 vs 41, 04 ± 1,71 years; NS), BMI (25,2±3,92 vs 25,35±4,09 Kgm-2 ; NS), infertility type (primary 41% vs 59%;NS ; ou secondary 58% vs 40,9% ; NS), FSH (9,98±2,42 vs 10,01±2,75 ; NS) and antral follicle count on day 3 (4,13±1,12 vs 3,8±1,16 FA ; NS). The estradiol rate, dosed on the onset day was significantly higher in the short protocol group (1534,27±1034,34 vs 1133,31±1053,58 pg/ml; p=0.034). However, the consumed quantity of gonadotrophins was lower in the short protocol group (1550±235,45 vs 1725,55±450,35 UI, p=0.01). A total of 13 cycles was stopped: 9 times for the long protocol (18.75 %) and 4 times for the short protocol (9.09 %) with statistically significant difference. The number of collected oocytes was significantly higher in the short protocol (7,64±3,70 vs 4,55±2,01, P<0.001). We significantly obtained more embryos in the short protocol (4,31±2,9 vs 2,16±2,2 embryos ; p<0,001). With higher number of grade 1 embryos (2,61 vs 1,14 embryons; p<0.001).The results in terms of pregnancy and living births show no significant difference between the 2 groups. CONCLUSION: The short protocol is more suited to the profile of ovarian poor responders. The long protocol standard has no place in poor responders. However, the long micro dose protocol and the long degressed micro dose protocol yield results at least equivalent to the short protocol.

[Short vs long agonist protocols in poor responders undergoing IVF]

Compare among poor responders: stimulation results, laboratory parameters and the final IVF results by assessing 2 different stimulation protocols: the long agonist protocol and the short agonist protocol. An analytical retrospective study carried out over of period of 2 years: January 2006 and December 2007. During this period, a total of 1192 IVF cycles of ICSI type were performed in 892 patients. Inclusion criteria: short agonist or antagonist stimulated patients protocols and presenting two of the three following criteria: 1- Patients aged more than 38 years with an FSH plasmatic rate on the 3rd day of the cycle 9.5 UI/ml. 2- Antral follicle count [AFC] 5 for both ovaries. 3- Failure of anterior ovary stimulation: abandonment of cycle or ‹ 3 oocytes at data collection in a previous cycle. Exclusion criteria: PCOS or single ovary. 65 patients, undergoing 92 attempts of ICSI cycles have been included in this study. Long agonist protocol was performed in 48 cases and Short agonist protocol was performed in 44 cycles. Both groups were comparable as to age [40,09 +/- 6, 59 vs 41, 04 +/- 1,71 years; NS], BMI [25,2 +/- 3,92 vs 25,35 +/- 4,09 Kgm-2 ; NS], infertility type [primary 41% vs 59%;NS ; ou secondary 58% vs 40,9% ; NS], FSH [9,98 +/- 2,42 vs 10,01 +/- 2,75 ; NS] and antral follicle count on day 3 [4,13 +/- 1,12 vs 3,8 +/- 1,16 FA ; NS]. The estradiol rate, dosed on the onset day was significantly higher in the short protocol group [1534,27 +/- 1034,34 vs 1133,31 +/- 1053,58 pg/ml; p=0.034]. However, the consumed quantity of gonadotrophins was lower in the short protocol group [1550 +/- 235,45 vs 1725,55 +/- 450,35 UI, p=0.01]. A total of 13 cycles was stopped: 9 times for the long protocol [18.75 %] and 4 times for the short protocol [9.09 %] with statistically significant difference. The number of collected oocytes was significantly higher in the short protocol [7,64 +/- 3,70 vs 4,55 +/- 2,01, P<0.001]. We significantly obtained more embryos in the short protocol [4,31 +/- 2,9 vs 2,16 +/- 2,2 embryos ; p<0,001]. With higher number of grade 1 embryos [2,61 vs 1,14 embryons; p<0.001].The results in terms of pregnancy and living births show no significant difference between the 2 groups. The short protocol is more suited to the profile of ovarian poor responders. The long protocol standard has no place in poor responders. However, the long micro dose protocol and the long degressed micro dose protocol yield results at least equivalent to the short protocol