found no difference in the LBRs between the two groups (22); and Marci et al. Ferroquine showed that, in patients with low ovarian reserve (AFC 7), the cLBR was significantly lower in the antagonist group than in the long agonist protocol group [OR (95% CI) 0.62 (0.41, 0.94)], which effect was more robust in younger patients (<30 y) [OR (95% CI) 0.29 (0.11, 0.74)]. The analysis also revealed remarkably lower cLBR in patients above 40 years regardless of their AFC, although the difference was not statistically significant. However, in patients with high ovarian Ferroquine reserve (AFC >24), the cLBR was higher in cycles with antagonist protocol than with the long agonist protocol [OR (95% CI) 1.43 (0.96, 2.12)], and the effect was of statistical significance in younger patients (< 30 y) [OR (95% CI) 1.78 (1.07, 2.96)]. Conclusion: The present study suggests that the flexible GnRH antagonist protocol might not be suitable for patients with low ovarian reserve (AFC 7) or patients aged over 40 years. However, flexible GnRH antagonist protocol might be strongly recommended for patients under 30 years old and with high ovarian reserve (AFC > 24). For the rest groups of patients in the present cohort, antagonist protocol was slightly favored because it had lower OHSS in general and in patients with poly-cystic ovarian syndrome (PCOS) according to previous publications. fertilization, ovarian reserve, GnRH antagonist, GnRH agonist, cumulative live birth rate Introduction fertilization and embryo transfer (IVF-ET) as the most effective treatment for infertility has been widely used worldwide. IVF is a multi-step process starting from ovarian stimulation with gonadotropins, then oocyte retrieval with subsequent fertilization procedures in the laboratory, and embryo culture followed by embryo transfer into the uterus. The controlled ovarian stimulation (COS) is the first step with the purpose of inducing maturation of multiple oocytes, and hence maximizing the chance of achieving successful pregnancy. However, multi-follicular development often results in premature elevation of estradiol followed by early luteinizing hormone (LH) surge and premature luteinization, which has been shown to affect 12.3C46.7% of fresh IVF cycles, and there is accumulating evidence confirming its negative effect on the overall success rates (1, 2). Two artificial gonadotropin releasing hormone (GnRH) analogs, GnRH agonist and GnRH antagonist, have been applied to address these issues, both of which are effective in blocking premature LH surge (3C5). GnRH agonist was the first GnRH analog introduced into COS to prevent the premature elevation of endogenous LH in 1984 (6). It competitively binds with the GnRH receptors in pituitary to slowly desensitize the pituitary. Short-acting GnRH agonist long protocol, also known as long protocol which starts from mid-luteal phase, has been the gold standard for pituitary downregulation method in COS worldwide nowadays, especially in young normo-gonadotropic women. The long protocol has plenty of advantages, such as maintaining stable and low LH and progesterone (P) levels throughout the stimulation phase, synchronized follicular development, good number of retrieved oocytes and short learning curve (6C8). But this suppression is related to clear disadvantages including the initial flare-up and menopausal symptoms (9). GnRH antagonist was developed about 40 years ago, but wasn’t widely applied in clinical practice until recently (3). It instantly blocks the pituitary LH secretion without any flare-up effect and is proved to be with shorter treatment duration, less use of gonadotropic hormones, improved patient acceptance, but with fewer follicles and oocytes when compared with standard long protocol in various clinical Ferroquine studies (4, 5, 10, 11). Advantages of GnRH antagonist as mentioned above, numerous clinical trials and meta-analyses (12, 13) based on the studies comparing GnRH agonist protocol and antagonist protocol have showed Rabbit polyclonal to EGFR.EGFR is a receptor tyrosine kinase.Receptor for epidermal growth factor (EGF) and related growth factors including TGF-alpha, amphiregulin, betacellulin, heparin-binding EGF-like growth factor, GP30 and vaccinia virus growth factor. a consistent conclusion that GnRH antagonist protocol results in similar live birth rate (LBR) but with significantly lower incidence of any grade OHSS in IVF regardless of treated population (14). Even in population with polycystic ovary syndrome (PCOS), clinical pregnancy.