pregnancy outcome in delayed start antagonist versus microdose flare gnrh agonist protocol in poor responders undergoing ivf/icsi: an rct

Background: over the years, many article on different aspects of pathogenesis and management of poor ovarian responders have been published but there is no clear guideline for treating themyet. objective: this study was designated to compare the effectiveness of a delayed start protocol with gonadotropin-releasing hormone (gnrh) antagonist and microdose flare-up gnrh agonist protocol in poor ovarian responders. materials and methods: this randomized clinical trial consisted of 100 poor ovarian responder women in assisted reproductive technologies cycles. they were divided randomly in delayed-start antagonist protocol (with estrogen priming followed by early follicular-phase gnrh antagonist treatment for 7 days before ovarian stimulation) and microdose flare-up gnrh agonist protocol. the main outcome was clinical pregnancy rate and second outcome was the number of retrieved oocytes, mature oocytes, 2pn number, fertilization rate, and implantation rate. results: fertilization rate, clinical pregnancy rate, and ongoing pregnancy rates were not significantly different between the two studied protocols. number of retrieved oocytes (5.10±3.41 vs. 3.08±2.51) with p=0.002, mature oocytes (4.32±2.69 vs. 2.34±1.80) with p=0.003, number of 2pn (3.94±1.80 vs. 2.20±1.01) with p=0.001 and implantation rate (19.40% vs. 10.30%) with p=0.022 were significantly higher in delayed antagonist group. conclusion: the delayed-start protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle development.