Enhancing the fertility of poor responders by treatment with estrogen rebound combined with a short protocol

Aim:  To assess the efficacy of estrogen rebound (ER) plus flare-up by gonadotropin releasing hormone agonist (GnRH-a) in poor responders who failed to become pregnant prior to a long protocol treatment.
Methods:  The patients comprised of thirty-one infertile patients with oocyte retrieval levels of less than five, who had undergone several long protocol treatment cycles. The efficacy of treatment with the ER plus flare-up from GnRH-a was compared with the prior long protocol treatment. The main outcome measures are: confirmation of ER, maximal serum E₂ levels prior to human chorionic gonadotropin (hCG) administration, follicular development, dose, and duration of gonadotrophins in a clinical setting.
Results:  The ER was confirmed by estrogen levels; FSH increased with ER plus flare-up from GnRH-a. Although the 31 patients included in the study had undergone frequent prior treatment cycles, including the long protocol, the pregnancy rate per embryo transfer following ER plus flare-up by GnRH-a was 37.5% (nine of 24). The number of follicles, number of oocytes retrieved, and the E₂ level was higher than those found in prior treatment cycles.
Conclusion:  Exogenous estrogen administration with Premarin^R plus flare-up by GnRH-a may represent an alternative and effective protocol for poor responder patients who had previously undergone several prior long protocol treatments. (Reprod Med Biol 2003; 2 : 127–131)