Gonadotropin-releasing hormone agonist flare-up versus Gonadotropin-releasing hormone antagonist protocols in poor responders undergoing Intra Cytoplasmic Sperm Injection ICSI.

Poor ovarian response (POR) is a multifactorial problem with less ovarian reserve and its incidence varies between 9% and 24%, therefore, early identification is It is better to reduce the risk of cycle cancellation as well as side effects. Purpose: To compare the use of Gonadotropin-releasing hormone GnRH flare-up versus GnRH antagonist protocol, in poor responders preparing for Intra Cytoplasmic Sperm Injection ICSI, as regards embryo quality, cycle parameters and clinical outcomes. Patients and methods: RCT included one hundred and six qualified poor responders performing ICSI were divided into 2 groups each containing 53 patients. Group 1 received GnRH flare-up protocol and group 2 received GnRH antagonist protocol. Data were collected for both groups. Results: No significant difference was found between both groups as regards patient age (p value 0.4), body mass index (p value 0.5), day 3 FSH level (p value 0.06), infertility cause, number of oocytes and MII oocytes and number of embryos transferred. Significant difference was found in the number of gonadotropin ampoules with less ampules in the flare-up group, 64 versus 76 ampules, peak estradiol level, which was higher in the flare-up group, 1192 versus 798 and the quality of embryos in favor of GnRH flare-up group (P-value= 0.017, 0.009 and 0.044) respectively. No significant difference was found in pregnancy and miscarriage rates (p value 0.90 and 0.87 respectively). Conclusion: Flare-up protocol is more effective than GnRH antagonist protocol as regards the improved embryo quality, with more top-quality embryos in the flare-up protocol group.