Expected Poor Responder can have Optimized Outcome with Modified Delayed Start Protocol

Abstract

Background: How to optimize the outcome in poor responders, is one of the biggest challenges in assisted reproductive techniques (ART).

Aim: To compare the efficacy of   modified delayed start protocol against the conventional Flexible antagonist protocol in poor responders.

Study Design: Prospective case control study included sixty infertile women defined as expected poor responders (Poseiden criteria group 3,4) who opted for self IVF stimulation. In case group (n=31), modified delayed-start GnRH antagonist protocol administered which comprises progesterone priming for 10 days in the luteal phase of previous cycle followed by early follicular-phase GnRH antagonist treatment for 3 days followed by ovarian stimulation with flexible antagonist protocol, were compared with baseline matched Control group (n=31) treated with flexible antagonist protocol for stimulation.

Results: The delayed start strategy improved clinical pregnancy rates, oocyte retrieval rates, and embryo quality over the usual approach. The delayed start group received far fewer gonadotropins in quantity and duration. Endometrial Thickness and cancelation rates were not significantly different.

Conclusion: The delayed start technique may improve IVF outcomes for expected poor responders. Additional studies with longer follow-ups and larger samples are needed to confirm these findings.