Agonist “flare-up” versus antagonist in the management of poor responders undergoing in vitro fertilization treatment

To compare the agonist flare-up and antagonist protocols in the management of poor responders to the standard long down-regulation protocol. Retrospective comparative study. Assisted conception center. One hundred thirty-four patients undergoing IVF/ intracytoplasmic sperm injection (ICSI) treatment, who responded poorly to the standard long down-regulation protocol in their first treatment cycle. In the second cycle, 77 received short flare-up agonist and 57 received antagonist protocol. We analyzed the outcome of the second cycle. Peak serum E 2 was assayed on the day of hCG administration. Cycle cancellation rate due to poor ovarian response. There was no cycle cancellation in the flare-up protocol and 7% cancellation rate in the antagonist protocol due to lack of response. A significantly higher number of patients had embryo transfer in the flare-up protocol. There was no difference in pregnancy rate (PR) between the two groups. Both the flare-up and the antagonist protocols significantly improved the ovarian response of known poor responders. However, a significantly higher cycle cancellation rate and less patients having embryo transfer in the antagonist group tips the balance in favor of the flare-up protocol.