Comparison Between Soft and Conventional Flexible Antagonist Protocols Regarding Endometrial Receptive Parameters for Women With Poor Ovarian Response and Effect on Pregnancy Rate

Nidhal Al-Tamimi; Manal Al-Obaidi; Lubna Amer Al-Anbari

doi:10.28969/IJEIR.v12.i2.r8.22

Authors

Nidhal Al-Tamimi High Institute of Infertility Diagnosis and Assisted Reproductive Technologies, Al Nahrain University, Baghdad, Iraq
Manal Al-Obaidi The High Institute for Infertility Diagnosis and Assisted Reproductive Technologies
Lubna Amer Al-Anbari The High Institute for Infertility Diagnosis and Assisted Reproductive Technologies

DOI:

https://doi.org/10.28969/IJEIR.v12.i2.r8.22

Keywords:

poor responders, antagonist protocol, soft protocol, conventional protocol, pulsatility index, Resistance index (RI)

Abstract

Poor ovarian responders (PORs) are characterized by decreased
the response of the ovaries to stimulation. Nowadays, using soft
protocol of low doses of Gn with/without oral compounds such as
letrozole was accepted as a good option. The endometrium receptive
parameters include sub endometrial resistance, pulsatility index and
endometrial thickness. Eighty infertile POR women divided to two
equal groups and undergoing IVF/ICSI antagonist protocols. One
group underwent soft protocol using letrozole 2.5mg twice daily for
5 days starting from cycle day 2-3 overlapped low-dose Gn (225 IU)
from cycle day 4-5. Other group received high dose Gn only (450
IU) from cycle day 2-3. Both groups continued stimulation cycle
until the day of trigger using the flexible antagonist protocol.
Estimation of values of sub endometrial RI and PI with endometrial
thickness by 2 Color Doppler ultrasound was performed at day of
trigger, OCP and ET. There was no significant difference for
endometrial thickness at day of trigger, OCP and ET. There was
significant difference in means of sub endometrial RI and PI at day
of trigger, OCP and ET (P>0.05). This study showed evidence in
favor of soft protocol for POR regarding pregnancy rates in spite of
the statically difference in means of sub endometrial RI and PI
associated with much less cost effectiveness.

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