Limitations in the Use of Combined Gonadotropin Releasing Hormone Analog and Human Menopausal Gonadotropin for In Vitro Fertilization

Modified Natural Cycle Using GnRH Antagonist Can Be an Optional Treatment in Poor Responders Undergoing IVF

“…Patients diagnosed as having a poor response often require greater doses of gonadotrophins but ultimately have fewer oocytes and with poor quality (2). Various ovulation induction regimens have been used to improve the success rate in those particularly difficult cases (3)(4)(5)(6)(7). Among these protocols, ovarian stimulation combined with gonadotrophin releasing hormone (GnRH) agonist is associated with in-1 IVF Unit -Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.…”

“…3 To whom correspondence should be addressed; e-mail: shaieliz@ netvision.net.il. creased doses of gonadotrophin (4,5). Recent studies pointed out the efficacy of GnRH antagonists in poor responders (8)(9)(10).…”

Evaluation and Treatment of Low Responders

“…The introduction of stimulation protocols containing GnRH agonists (GnRH-a) in the late 1980s provided new opportunities to stimulate patients who previously had limited responses to gonadotropins. [39][40] Initial reports indicated that some low responders stimulated better following luteal phase administration of a GnRH-a. [39][40][41] Subsequent clinical experience has provided disappointing results.…”

“…[39][40] Initial reports indicated that some low responders stimulated better following luteal phase administration of a GnRH-a. [39][40][41] Subsequent clinical experience has provided disappointing results. In fact, many patients who are low responders may be completely refractory to stimulation after being down regulated with a GnRH-a.…”