Gonadotropin-releasing hormone agonist/antagonist conversion with estrogen priming in low responders with prior in vitro fertilization failure

Objective

To evaluate gonadotropin-releasing hormone (GnRH) agonist/antagonist conversion with estrogen priming (AACEP) in low responders with prior IVF failure.

Design

Descriptive.

Setting

Private practice.

Patient(s)

Women aged ≤42 with prior IVF attempts in which all embryos were <7 cells or >20% fragmentation on day 3 (n = 137; <38: n = 63; 38-42: n = 74). In addition to unexplained poor response to stimulation (n = 52), diagnoses included elevated follicle-stimulating hormone (FSH >9.0 mIU/mL; n = 40), advanced age (>41 years; n = 26), endometriosis (III–IV; n = 12), and decreased ovarian reserve (AFC <5; n = 7).

Intervention(s)

Patients received sequential GnRH agonist, low-dose GnRH antagonist, and estradiol valerate followed by recombinant FSH, 600 IU/day (n = 72) or 750 IU/day (n = 65).

Main Outcome Measure(s)

Pregnancy, ongoing gestation, implantation rates.

Result(s)

Although women aged <38 years and those on 600 IU/day produced more mature eggs and fertilized embryos than women aged 38 to 42 years, there were no differences in peak estradiol, endometrial lining, or embryos transferred. Outcomes were similar for all patients regardless of age or FSH dosage. Ongoing gestation rates were 27% (37 out of 137) for all patients, 25% (16 out of 63) for age <38 years, and 28% (21 out of 74) for ages 38 to 42 years.

Conclusion(s)

Women aged ≤42 years who are candidates for oocyte donation may still achieve pregnancy using their own eggs with the AACEP protocol.

Key Words: GnRH agonist, GnRH antagonist, estrogen priming, IVF failure