Double Ovarian Stimulation Versus Using Antagonist with a High Dose of Gonadotropin in Women with Poor Ovarian Response: A Randomized Clinical Trial Study

Farnaz Montazeri; Zhaleh Zolghadri; Katayoun  Yazd chi; Simin Zafardoust; Zahra Sehat

doi:10.18502/jimc.v7i4.16641

Farnaz Montazeri Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran
Zhaleh Zolghadri Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran
Katayoun Yazd chi Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran
Simin Zafardoust Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
Zahra Sehat Avicenna Infertility Clinic, Avicenna Research Institute, ACECR, Tehran, Iran

DOI: https://doi.org/10.18502/jimc.v7i4.16641

Keywords: Gonadotropin, Infertility, Oocytes, Ovulation induction

Abstract

Background: Poor Ovarian Response (POR) to ovarian stimulation is a challenging factor in Assisted Reproduction Technology (ART). This study aimed to compare the efficacy of a conventional antagonist with high doses of gonadotropin protocol with double stimulation protocol in females with POR.

Methods: This randomized clinical trial study was conducted on 60 women aged >35 with PORS at the Avicenna Infertility Center, Tehran, Iran. The participants were randomly divided into 2 groups (n=30 /each). In group 1, from the second day of the menstrual cycle, gonadotropin started at a dose of 450-600 units. In group 2, the second day of the menstrual period began with Letrozole 5 mg every night and an oral tablet of Clomiphene citrate 50 mg every day, and from the fourth day started 150 units of gonadotrophin (Triptorelin, 0.2 mg).

Results: In this study, at the end of the follicular phase, there was a significant correlation between protocol type and the number of Germinal Vesicles (GV) (p=0.04). The mean number of oocytes retrieved was 2.76±1.9 in the conventional method and 3.23±2.1 in the double stimulation group (p=0.90). The number of fertilized oocytes was 31 in the conventional protocol and 25 in the double stimulation protocol. The mean number of pregnancies that led to the fetus was 1.38±1.3 in the conventional protocol and 0.96±0.9 in the double stimulation group (p=0.018).

Conclusion: The results of this study show that the embryos in the double-stimulation group were more capable of completing the pregnancy, and the double-stimulation group had a higher live birth rate.