GnRH拮抗剂方案中HCG扳机时机对胚胎的影响

目的:探讨促性腺激素释放激素拮抗剂(GnRH antagonist)方案超促排卵过程中推迟人绒毛膜促性腺激素(HCG)扳机时机对胚胎质量及妊娠率等的影响。方法:回顾性分析2015年1月至12月在我院接受体外受精-胚胎移植(IVF-ET)助孕的不孕症患者183例,均采用GnRH拮抗剂促排方案,于月经周期第2天启用促性腺激素(Gn),当有卵泡平均直径达到14mm,加用GnRH拮抗剂。按照传统HCG扳机时机(有3个≥17mm卵泡)与推迟1天扳机分为2组:早期HCG组(149例)和晚期HCG组(34例),比较两组数据。结果:HCG扳机日,晚期HCG组≥15mm的卵泡数明显多于早期HCG组(P=0.026)。晚期HCG组Gn使用天数及Gn使用总量均明显高于早期HCG组(P=0.000,P=0.012)。妊娠结局方面,晚期HCG组较早期HCG组具有更高的妊娠率(76.00%vs 50.45%,P=0.020)。两组受精率、继续妊娠率、流产率、异位妊娠率均无显著差异(P0.05)。结论:GnRH拮抗剂促排方案中,适当推迟HCG扳机时间不影响胚胎质量和妊娠率,可以推行。     

卵巢反应正常者卵泡中晚期添加黄体生成素对体外受精-胚胎移植结局影响研究

目的探讨卵巢反应正常者超促排卵过程中添加黄体生成素(LH)对体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析2014年1月至2016年1月汕头市中心医院生殖中心接受IVF-ET治疗的360例卵巢反应正常的不孕患者的临床资料,研究对象均于月经第3~5天行重组人促卵泡激素(r-FSH)促超排卵,当卵泡最大直径达14 mm时,按LH水平分为3组,1组:LH1 U/L,2组:1 U/L≤LH2 U/L,3组:LH≥2 U/L。每组再分为A组:继续使用r-FSH至人绒毛膜促性腺激素(HCG)注射日;B组:每日添加人绝经期促性腺激素(HMG);C组:每日添加r-LH。比较各组的临床结局。结果 3组中不添加LH的A组中A1组的促性腺激素(Gn)时间,r-FSH用量,流产率高于A2、A3组;妊娠率A1、A2低于A3组,差异有统计学意义(P0.05)。小组内A1组促性腺激素r-FSH用量、Gn时间、流产率显著高于B1、C1组,受精率及妊娠率显著低于B1、C1组,差异有统计学意义(P0.05);A1、B1、C1组3组间添加LH日及HCG日血清LH水平、获卵数差异均无统计学意义(P0.05)。A2组妊娠率显著低于B2、C2组,r-FSH用量、Gn时间、获卵数、流产率、添加LH日及HCG日血清LH水平差异均无统计学意义(P0.05)。A3、B3、C3组间各项指标差异均无统计学意义(P0.05)。结论对卵巢反应正常者,降调时LH水平过低影响临床结局;卵泡中晚期在LH2 U/L时添加r-LH可提高妊娠率,尤其血清LH1 U/L时添加r-LH可获较好的临床结局,LH≥2 U/L时不能从添加r-LH中获益。在相同LH水平时添加HMG和r-LH疗效无差异。     

拮抗剂方案不同扳机药物对IVF/ICSI-ET患者临床妊娠结局的影响

目的:观察拮抗剂方案中应用不同扳机药物对体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)患者妊娠结局的影响。方法:回顾性分析2017年1月至2020年6月行IVF/ICSI-ET助孕患者的临床资料,根据拮抗剂方案中扳机用药不同分为促性腺激素释放激素激动剂(GnRH-a,0.1 mg)+绒促性素(HCG,2000 U)组和HCG组(10000 U),经1∶1倾向性匹配评分后,两组各79例。比较两组扳机日激素水平[雌二醇(E₂)、孕酮(P)、促黄体生成素(LH)]、卵泡直径、卵泡微环境[胰岛素样生长因子I(IGF-I)、胰岛素样生长因子结合蛋白I(IGFBP-I)]、促排卵助孕及妊娠结局,并评价不同卵巢储备功能的妊娠结局。结果:(1)两组扳机日E₂、P、LH水平及直径≥18 mm卵泡数比较,差异无统计学意义(P>0.05);(2)GnRH-a+HCG组取卵日血清及卵泡液IGF-1、IGFBP-1水平均较HCG组明显升高(P<0.05)。(3)GnRH-a+HCG组成熟卵数、可利用胚胎数、优质胚胎数、受精率、卵子利用率、优质胚胎率均较HCG组升高(P<0.05);GnRH-a+HCG组卵巢过度刺激综合征(OHSS)发生率(1.27%)较HCG组(11.39%)明显下降(P<0.05);但两组生化妊娠率、临床妊娠率、流产率及活产率比较,差异均无统计学意义(P>0.05)。(4)卵巢储备功能正常(106例)患者中,GnRH-a+HCG组成熟卵数、可利用胚胎数、优质胚胎数、受精率、卵子利用率、优质胚胎率均较HCG组升高(P<0.05),OHSS发生率较HCG组下降(P<0.05);DOR(52例)患者中,GnRH-a+HCG组成熟卵数、可利用胚胎数、优质胚胎数、优质胚胎率、活产率均较HCG组升高(P<0.05)。结论:IVF/ICSI-ET患者采取GnRH-a联合HCG扳机可更好改善卵泡微环境,有利于提高胚胎质量、减少OHSS风险,且无论患者卵巢储备功能正常与否,均能从GnRH-a联合HCG扳机中获得一定收益。     

人绒毛膜促性腺激素注射日卵泡大小与体外受精-胚胎移植妊娠率的关系

目的探讨体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)的控制性超促排卵(COH)周期中人绒毛膜促性腺激素(HCG)注射日卵泡径线与妊娠率的相关性。方法回顾性分析2008年1月至2009年6月首次在中国医科大学附属盛京医院接受IVF-ET或卵胞浆内单精子注射-胚胎移植(ICSI-ET)治疗的患者共364周期,并根据HCG日最大卵泡径线分为:A组(14≤D≤16 mm),B组(16.5≤D≤17 mm),C组(17.5≤D≤18 mm),D组(18.5≤D≤20mm)和E组(D20 mm)来分析HCG日的卵泡径线与妊娠结局的关系。结果 5组妊娠率分别为50.00%,64.29%,57.01%,33.33%,29.78%,差异有统计学意义(P0.05)。随着组别的升高,促性腺激素(Gn)使用时间延长,但获卵数、受精率、卵裂率和优质胚胎占有率差异无统计学意义(P0.05)。结论体外受精-胚胎移植治疗COH周期中,主导卵泡径线在14～18 mm时决定HCG注射可以得到较高的临床妊娠率,当卵泡经线超过18mm时,胚胎继续发育潜能降低,临床妊娠率降低。     

GnRH拮抗剂及激动剂在控制卵巢过度刺激的周期形成及颗粒—黄体细胞甾体产物的作用

近年来,许多学者在体外受精,配子输卵管内移植的病人应用促性腺激素释放激素(GnRH)激动剂治疗的助孕技术中所形成的卵巢过度刺激综合征(OHS),取得一定疗效。而GnRH激动剂的作用开始刺激兴奋垂体,使卵泡发育期有高的LH水平,加重OHS。因此GnRH拮抗剂将成为治疗OHS的有     

不同预处理促性腺激素拮抗剂方案在超促排卵中应用的临床分析

目的:探讨如何在体外受精-胚胎移植(IVF-ET)周期中更有效地运用拮抗剂方案。方法:回顾性分析319个使用拮抗剂方案进行IVF-ET无输卵管积液、无内膜息肉及无子宫解剖结构异常的新鲜移植周期。根据拮抗剂治疗前使用短效激动剂(n=125,A组)、口服避孕药(达英-35)(n=113,B组)和未处理组(n=81,C组)分组,比较各组患者的年龄、促性腺激素(Gn)使用天数和剂量、注射hCG日LH和E2水平、获卵数、优质胚胎率、临床妊娠率等。同时以261个促性腺激素激动剂长方案移植周期为对照组(D组)作进一步对比。结果:C组年龄(32.9±4.8岁)较其它组年龄明显偏大,P<0.05;A和B组Gn使用剂量大于C组,其中A组明显增多(P<0.01);A和B组hCG注射日LH水平均较C组明显低,其中A组LH值最低(P<0.01);A组获卵数最多(P<0.05);B组子宫内膜最薄(P<0.01)。3组的受精率、优质胚胎率均无统计学差异(P>0.05)。A组、B组和C组临床妊娠率分别为:32.8%、17.7%和37.0%,B组临床妊娠率显著低于A、C组(P<0.01)。C组、D组间临床妊娠率比较无统计学差异(37.0%vs 40.2%,P>0.05);C组Gn使用的时间和剂量均比D组明显减少(P<0.05)。结论:在IVF-ET中GnRH拮抗剂治疗前使用达必佳预处理未能提高妊娠率,使用过达因-35避孕的患者妊娠率明显下降,而未使用任何药物的患者接受GnRH拮抗剂超促排卵方案,能获得比较好的临床结局。     

阴道超声下最大卵泡经线及主导卵泡群比例对体外受精-胚胎移植结局的影响

目的:分析人绒毛膜促性腺激素(HCG)注射日最大卵泡直径及主导卵泡群比例对体外受精-胚胎移植(IVF-ET)结局的影响,以探讨HCG扳机的超声标准。方法:回顾分析2010年6月至2012年6月在河南省人民医院生殖所接受IVF-ET治疗的患者共2566周期,根据HCG日最大卵泡径线(D)分为:A组(D≤18mm)、B组(18mmD≤21mm)、C组(21mmD≤24mm)、D组(24mmD≤27mm)和E组(D27mm),比较5组的年龄、基础FSH、HCG日E2、HCG日≥14mm卵泡数、HCG日主导卵泡比例、2PN数、可移植胚胎数、胚胎着床率、临床妊娠率等。结果:A、B组HCG日≥14mm卵泡数、HCG日≥20mm比例及HCG日≥18mm比例显著低于其余3组,A组显著低于B组,差异均有统计学意义(P0.001):A、B组的HCG日≥16mm比例、胚胎着床率、临床妊娠率均低于C、D、E组,差异有统计学差异(P0.001)。5组患者的年龄、基础FSH、卵子数、2PN数、可移植胚胎数、早期流产率等比较,差异均无统计学意义(P0.05)。结论:HCG日扳机的超声标准应以主导卵泡群比例为主要参考指标并兼顾最大卵泡直径,各主导卵泡群的比例:HCG日≥20mm卵泡比例35%、≥18mm卵泡比例55%~60%、≥16mm卵泡比例80%;最大卵泡直径21mm。     

补充黄体生成素对控制性超促排卵过程中卵巢慢反应患者临床结局的影响

目的:评价控制性超促排卵(COH)过程中卵巢慢反应患者补充重组黄体生成素(rLH)或人绝经期促性素(HMG)的有效性。方法:选取行长方案体外受精(IVF)或卵胞浆内单精子注射(ICSI)治疗的患者101例,均给予重组卵泡刺激素(rFSH)。将COH第7~8天血清黄体生成素(LH)持续正常者作为对照组(A组,n=34);将LH水平持续较低者随机分为两组,补充HMG组(B组,n=34)或rLH组(C组,n=33)。比较3组患者的临床结局。结果:B组患者的COH天数及rFSH用量均显著低于A组和C组(P0.05);C组的HCG日雌二醇(E2)水平、获卵数及双原核(2PN)受精率显著高于A组和B组(P0.05)。3组的促性腺激素(Gn)用量、HCG日LH、孕酮(P)、优质胚胎率及临床妊娠率比较,差异均无统计学意义(P0.05)。结论:对COH过程中卵巢慢反应的患者,补充HMG可减少COH天数及rFSH用量,降低治疗费用;补充rLH可改善卵巢的反应性,提高HCG日E2水平,增加获卵数及受精率,改善妊娠结局。     

卵巢过度刺激综合征的诱发因素及其防治

卵巢过度刺激综合征（ovarian hyperstimulation syndrome,OHSS）是一种发生于促排卵后黄体阶段或妊娠早期的医源性并发症.无论是氯米芬（CC）或促性腺激素（Gn）促排卵,甚至联合应用促性腺激素释放激素（GnRH）激动剂（agonists）或GnRH拮抗剂（antagonists）,在注射促排卵药物人绒毛膜促性腺激素（HCG）后都有可能发生OHSS.     

GnRH-a联合低剂量HCG诱发卵母细胞成熟在行PGD/PGS助孕患者中的应用

目的:探讨促性腺激素释放激素拮抗剂(GnRH-ant)方案中促性腺激素释放激素激动剂(GnRH-a)联合低剂量绒促性素(HCG)扳机对行胚胎植入前遗传学诊断/筛查(PGD/PGS)助孕患者促排卵的效果。方法:回顾性分析2015年1月至2016年3月在我院因女方染色体异常行GnRH-ant方案中GnRH-a联合低剂量HCG双扳机诱导卵泡成熟的PGD/PGS助孕患者79例(A组),根据年龄、抗苗勒管激素(AMH)、基础卵泡刺激素(FSH)匹配选取行拮抗剂方案促排卵并单纯使用HCG扳机诱导卵泡成熟患者79例(B组)作对照,比较两组促排卵特点及促排卵结局。结果:两组促性腺激素总量、促排天数、HCG日雌二醇(E2)、HCG日孕酮(P)、HCG日黄体生成素(LH)、回收卵数、2个原核(2PN)数、第3天(D3)胚胎数、活检正常胚胎数、新发异常率差异均无统计学意义(P0.05)。与B组相比,A组获成熟卵数、D3优质胚胎数、形成囊胚数、优质囊胚数及优质囊胚率明显升高(P0.05),检测后正常的胚胎数虽然两组差异无统计学意义,但A组有升高趋势,两组OHSS发生率无明显差异(P0.05)。结论:GnRH-ant方案中GnRH-a联合HCG诱发卵母细胞成熟改善了行PGD/PGS助孕患者促排结局。     

Premature luteinization during gonadotropin-releasing hormone antagonist cycles and its relationship with in vitro fertilization outcome

OBJECTIVE: To determine the prevalence and the effect of premature luteinization in GnRH antagonist IVF-ET cycles. DESIGN: Prospective observational study. SETTING: In vitro fertilization-embryo transfer (IVF-ET) program at the Instituto Valenciano de Infertilidad. PATIENT(S): Eighty-one infertile patients undergoing controlled ovarian hyperstimulation with gonadotropins and GnRH antagonist for IVF-ET. INTERVENTION(S): Gonadotropin-releasing hormone (GnRH) antagonist was administered from stimulation day 6. Serum P, E(2), and LH were determined on the day of hCG administration. MAIN OUTCOME MEASURE(S): Cycles were grouped according to serum P level on the day of hCG administration (<1.2 ng/mL or > or =1.2 ng/mL). Clinical pregnancy and implantation rates were determined. RESULT(S): The incidence of premature luteinization was 38.3%. Total recombinant FSH dose and stimulation days differed significantly between the groups. Pregnancy rate (25.8% vs. 54.0%) and implantation rate (13.8% vs. 32.0%) were significantly lower in the premature luteinization group. CONCLUSION(S): Premature luteinization during GnRH antagonist IVF-ET cycles is a frequent event that is associated with lower pregnancy and implantation rates. Progesterone elevations are not related to serum LH levels and may reflect the mature granulosa cell response to high FSH exposure.     

IVF-ET中卵巢低反应患者拮抗剂方案中应用生长激素的研究

目的:研究卵巢低反应(POR)患者采用拮抗剂方案加用生长激素(GH)对子宫内膜容受性及妊娠结局的影响。方法:对采用拮抗剂方案促排卵行体外受精-胚胎移植(IVF-ET)助孕的188例POR患者的资料进行回顾性分析。以加用GH者为研究组(n=98),其余不加用GH者为对照组(n=90),比较组间的临床资料、实验室数据及妊娠结局,以评估GH治疗对POR患者的临床疗效。结果:研究组的Gn使用时间、Gn RH-A使用时间及总Gn使用量显著少于对照组,而获卵数、MII卵子数、受精卵数、优质胚胎数、h CG注射日血E2水平均显著高于对照组,差异均有统计学意义(P0.05);h CG注射日子宫内膜厚度组间比较差异无统计学意义(P0.05),但研究组子宫内膜血流改善显著,差异有统计学意义(P0.05);研究组生化妊娠率、临床妊娠率、种植率、活产率略高于对照组,但差异无统计学意义(P0.05)。结论:对于POR患者,GH改善了子宫内膜血流,可能提高了子宫内膜容受性,但对妊娠结局没有改善。     

Extended high dose letrozole regimen versus short low dose letrozole regimen as an adjuvant to gonadotropin releasing hormone antagonist protocol in poor responders undergoing IVF-ET*

Objective.?To compare the efficacy and cost-effectiveness of extended high dose letrozole regimen/HPuFSH-gonadotropin releasing hormone antagonist (GnRHant) protocol with short low dose letrozole regimen/HPuFSH-GnRHant protocol in poor responders undergoing IVF-ET.

Methods.?In this randomized controlled trial, 136 women who responded poorly to GnRH agonist long protocol in their first IVF cycle were randomized into two equal groups using computer generated list and were treated in the second IVF cycle by either extended letrozole regimen (5 mg/day during the first 5 days of cycle and 2.5 mg/day during the subsequent 3 days) combined with HPuFSH-GnRHant protocol or short letrozole regimen (2.5 mg/day from cycle day 3–7) combined with HPuFSH-GnRHant protocol.

Results.?There were no significant differences between both groups with regard to number of oocytes retrieved and clinical pregnancy rate (5.39 ± 2.08 vs. 5.20 ± 1.88 and 22.06% vs. 16.18%, respectively).The total gonadotropins dose and medications cost per cycle were significantly lower in extended letrozole group (44.87 ± 9.16 vs. 59.97 ± 14.91 ampoules and 616.52 ± 94.97 vs. 746.84 ± 149.21 US Dollars ($), respectively).The cost-effectiveness ratio was 2794 $ in extended letrozole group and 4616 $ in short letrozole group.

Conclusion.?Extended letrozole regimen/HPuFSH-GnRHant protocol was more cost-effective than short letrozole regimen/HPuFSH-GnRHant protocol in poor responders undergoing IVF-ET.     

促排卵过程中子宫内膜厚度变化对IVF-ET结局的影响

目的:探讨促排卵过程中子宫内膜厚度变化趋势对IVF结局的影响,以及不同促排卵方案对子宫内膜厚度变化趋势的影响。方法:回顾性分析1 173个IVF-ET周期,控制性促排卵方案包括:长方案(568例)、口服避孕药(OC)+GnRHa方案(425例)、拮抗剂方案(107例)和超长方案(73例)。比较各种促排卵方案的妊娠组与非妊娠组的子宫内膜厚度变化情况,包括Gn启动当日、启动后第5日、hCG注射日及子宫内膜差值1(=启动后第5日内膜厚度-启动当日内膜厚度)、子宫内膜差值2(=hCG注射日内膜厚度-启动后第5日内膜厚度)、子宫内膜差值3(=hCG注射日内膜厚度-启动当日内膜厚度)。结果:hCG注射日子宫内膜厚度妊娠组均较未妊娠组显著增加(P<0.05);Gn启动当日子宫内膜厚度、促排卵第5日子宫内膜厚度、子宫内膜厚度差值1、差值2、差值3妊娠组与未妊娠组间均无统计学差异(P>0.05)。结论:促排卵过程中子宫内膜厚度的变化趋势不能预测IVF结果,不同的促排卵方案不影响子宫内膜厚度的变化趋势。     

多囊卵巢综合征患者hCG注射日血清睾酮水平对IVF-ET结局的影响

目的:探讨多囊卵巢综合征患者hCG注射日血清睾酮(T)水平对IVF-ET结局的影响。方法:因顽固性排卵障碍而行IVF助孕的187例PCOS患者,于促排卵前均口服短效避孕药预治疗3￣6个月,T降至正常水平后,采用GnRHa长方案,观察比较妊娠组和非妊娠组hCG注射日血清T水平、获卵数、受精率、优质胚胎率。结果:非妊娠组T水平明显高于妊娠组,受精率及优质胚胎率均低于妊娠组,差异有统计学意义。结论:PCOS患者促排卵过程中T明显升高,可能对卵子质量及妊娠结局产生不良影响。     

The use of gonadotropin-releasing hormone antagonist in a flexible protocol: a pilot study

OBJECTIVE: The purpose of this study was to investigate the efficacy of a flexible protocol of starting gonadotropin-releasing hormone antagonist according to the size of the leading follicle. STUDY DESIGN: This was a pilot study that included 123 couples who were undergoing in vitro fertilization/intracytoplasmic sperm injection cycles at the Egyptian IVF-ET Center. Couples were recruited into two groups: group I (n=64), gonadotropin-releasing hormone antagonist was administered when the diameter of the leading follicle reached 16 mm; group II (n=59), gonadotropin-releasing hormone antagonist was administered on day 6 of stimulation. RESULTS: The mean number of antagonist injections was significantly lower in the flexible protocol compared to the fixed protocol (3.4+/-1.1 vs 5.3+/-1.8, P<.05). There was no significant difference between the two protocols regarding the number of embryos, implantation rate, clinical pregnancy rate (odds ratio, 0.85; 95% CI, 0.45-1.59) or multiple pregnancy rate (odds ratio, 1.26; 95% CI, 0.45-3.51). CONCLUSION: Starting the gonadotropin-releasing hormone antagonist according to the size of the leading follicle is as effective as starting on a fixed day and reduces the antagonist administration.     

剖宫产后阴道试产结局的多因素分析

目的探讨联合使用来曲唑促排卵对卵巢高反应患者雌激素水平及妊娠结局的影响。方法回顾性分析2012年3月至2015年3月行体外受精-胚胎移植(IVF-ET)的卵巢高反应患者291例。其中使用促性腺激素释放激素拮抗剂方案促排卵患者179例,根据促排卵过程中是否使用来曲唑分为来曲唑组(n=93)和拮抗剂组(n=86);长方案组112例。比较三组患者促排卵过程中各项指标和妊娠结局。结果来曲唑组h CG注射日的平均雌二醇(E2)水平、单个大卵泡E2水平均显著地低于拮抗剂组和长方案组(P 0.05)。来曲唑组获卵数及可利用胚胎数均低于拮抗剂组及长方案组(P 0.05),但是来曲唑组的胚胎种植率、冻融胚胎移植周期临床妊娠率及活产率等优于拮抗剂组(P 0.05);三组的平均移植次数比较,差异有统计学意义(P 0.05)。来曲唑组的卵巢过度刺激综合征(OHSS)发生率最低。结论与长方案、拮抗剂方案比较,联合使用来曲唑促排卵在不影响促排卵治疗结局情况下,能有效地降低高反应患者h CG注射日E2水平及单个大卵泡E2水平。因此,来曲唑可能在雌激素依赖性肿瘤患者的促排卵治疗中有潜在的应用价值。     

Protocol of GNRH antagonist in poor responders in IVF-ET cycles

INTRODUCTION: Response to stimulation is one of the factors that affect the results of infertility treatment in IVF-ET cycles. Poor responders as well as the occurrence of ovulation prior to the oocyte retrieval is a main reason of nearly 30% of cancellations of the treatment cycles. In poor responders high doses of gonadotrophins are sometimes required. However administration of gonadotrophins alone does not prevent premature LH surge. The aim of the study was to assess controlled ovarian stimulation protocols with GnRH antagonists (Cetrotide) in poor responders. MATERIAL AND METHODS: The study group consisted of 27 infertile women, mean age 35.8 (range 28-45) undergoing the second IVF cycle. In those women the first cycle was either cancelled due to the lack of follicles' development or the small number of growing follicles (1-2). Ovarian stimulation was started on the 2 day of cycle with administration of 225 IU or rFSH or hMG. Cetrotide was administered subcutaneously in a daily dose of 0.25 mg starting when estradiol serum concentration reached 150 pg/ml with a lead follicle 14 mm diameter and continued throughout the gonadotrophin treatment until HCG administration. RESULTS: In 31 cycles the mean number of MII oocytes retrieved was 4.71 (range 1-10). In one woman there was no mature oocytes obtained during pick-up. In one case the cycle was cancelled due to the bad response. The mean duration of cetrotide administration was 5.16 days. The mean number of rFSH and HMG ampoules was 23 and 30 respectively. The fertilisation rate was 64%. Embryo transfer was performed on the 3rd day after pick-up. The pregnancy rate in this group was 22%. There weren't any adverse effects of Cetrotide in treated women. No case of ovarian hyperstimulation syndrome occurred. CONCLUSION: Ovarian stimulation protocol with GnRH antagonist is effective in poor responders in IVF-ET cycles.