The definition of poor responders and the heterogeneity of this group of patients cause an important bias in published series. The rational for using ovarian stimulation protocols with GnRH-nt in poor responders is that GnRH-nts do not require desensitization and are not causing an important depression on gonadotropin secretion during the stimulation.
Forty-two patients who are poor responders were divided into two groups for ICSI treatment (long GnRH agonist or Cetrorelix multiple-dose protocols) (65). The stimulation protocol also included, in some patients, clomiphene citrate associated with gonadotropins. Age, number of oocytes retrieved, number of fertilized oocytes, transferred embryos, score of embryo quality, and clinical pregnancy were not significantly different between the groups. A trend was observed in the pregnancy rates (14.28% for Cetrorelix vs. 9.52% for GnRH agonist treatment) but the difference was not significant. The authors discussed the sample size utilized. Probably, with an adequate power calculation this difference in terms of pregnancy rate can become statistically important.
With the same objective of the above-mentioned paper, Akman et al. (66) presented a randomized trial comparing the microdose flare-up GnRH-a protocol versus the antagonist multiple dose protocol. Forty-eight patients were divided into the two regimen protocols. The implantation rates (15.07% for flare-up protocol and 11.36% for Cetrorelix) and the ongoing pregnancy rates per transfer (21.05% and 16.6% for flare-up and Cetrorelix protocol, respectively) were similar between the two groups.
Other small studies have been published recently (67-69). Those studies did not find an improvement in pregnancy rates, but similar results were achieved.
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