The gonadotropin-releasing hormone agonist stimulation test - A sensitive predictor of performance in the flare-up in vitro fertilization cycle

Objective: To evaluate the initial versus early pattern of estradiol (E₂) change after administration of a gonadotropin-releasing hormone agonist (GnRH-a), i.e., the GnRH-a stimulation test versus E₂ pattern, respectively, as predictors of ovarian response and pregnancy in in vitro fertilization (IVF) patients stimulated with a flare-up protocol. Design: Prospective study in a consecutive group of patients. Setting: Tertiary care, institutional setting. Patients: Two hundred twenty-eight patients entered and completed the study. The only patients excluded from study were those anticipated to have polycystic ovarian disease, those with a single ovary, or those with an ovarian cyst(s). Interventions: Patients were stimulated with a GnRH-a flare-up protocol beginning on menstrual day 2. Main Outcome: Evaluation of the GnRH-a stimulation test and the E₂ pattern as predictors of the number of mature oocytes retrieved and pregnancy. Results: The GnRH-a stimulation test but not the E₂ pattern was predictive of the number of mature oocytes retrieved (r = 0.53, P < 1 x 10^-5) and pregnancy (χ² = 8.5, P = 0.04). The E₂ pattern was predictive of the duration and number of ampules of gonadotropin required for stimulation. Conclusion: The GnRH-a stimulation test is a sensitive predictor of performance in the flare-up IVF cycle.