Effective Management of Single Dominant Follicle with Continuous Administration of Gonadotropin-Releasing Hormone Agonist

Abstract

With the widespread use of gonadotropin-releasing hormone agonist (GnRH-a) for in vitro fertilization(IVF) program, the cancellation rate during controlled ovarian hyperstimulation(COH} is much lowered. However, poor responders with poor estradioI(E2} rise or single dominant follicle still persist in GnRH-a combined COH, and the decision to cancel the cycle and the counselling of further cycles remain very perplexing. Three poor responders with single dominant follicle during GnRH-a combined COH for IVF were, rather than being cancelled, managed by continuous administration of GnRH-a and restimulation with initial low dosage and subsequent high dosage of follicle-stimulating hormone until an appropriate number of follicles was obtained. While no pregnant case treated in this way, the management resulted in a higher E2 level, and more oocytes and embryos. We suggest that this approach could serve as an alternative to cancellation in GnRH-a combined COHo