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Ultra-low–dose and very-low–dose Lupron downregulation protocols for poor responders based on POSEIDON group 3 and 4 classifications

  • Assisted Reproduction Technologies
  • Published:
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Abstract

Purpose

The objective of this study was to assess if very-low–dose Lupron (VLDL) and ultra-low–dose Lupron (ULDL) protocols can have comparable cycle outcomes when compared to other “poor responder” stimulation protocols based on POSEIDON classification groups 3 (PG3) and 4 (PG4).

Methods

A retrospective cohort study at a single, large academic center was performed. Women in PG3 (age < 35, AMH < 1.2 ng/mL) or PG4 (age ≥ 35, AMH < 1.2 ng/mL) undergoing in vitro fertilization using an ULDL (Lupron 0.1 to 0.05 mg daily), VLDL (Lupron 0.2 to 0.1 mg daily), microflare (Lupron 0.05 mg twice a day), estradiol priming/antagonist, antagonist, or minimal stimulation protocols from 2012 to 2021 were included. The primary outcome was the number of mature oocytes (MII) obtained. The secondary outcome was live birth rate (LBR).

Results

The cohort included 3601 cycles. The mean age was 38.1 ± 3.8 years. In the PG3 group, ULDL and VLDL protocols produced a comparable number of MIIs (5.8 ± 4.3 and 5.9 ± 5.4, respectively) and live births (33.3% and 33.3%, respectively) when compared to other protocols. In the PG4 group, ULDL and VLDL protocols resulted in a higher percentage of MIIs when compared to microflare or minimal stimulation (Microflare/ULDL: adjusted relative risk (aRR) 0.78 (95% CI 0.65, 0.95); min stim/ULDL: aRR 0.47 (95% CI 0.38, 0.58); microflare/VLDL: aRR 0.77 (95% CI 0.63, 0.95); min stim/VLDL: aRR 0.47 (95% CI 0.38, 0.95)). There were no significant differences in LBR.

Conclusion

Dilute Lupron downregulation protocols have comparable outcomes to other poor responder protocols and are reasonable to use.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivtiy. Data are available from the corresponding author upon reasonable request and with permission from the Mass General Brigham Institutional Review Board and Brigham and Women’s Hospital.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Zachary W. Walker, Andrea Lanes, Serene S. Srouji, Mark D. Hornstein & Elizabeth S. Ginsburg

  2. Harvard Medical School, Boston, MA, USA

    Zachary W. Walker, Andrea Lanes, Serene S. Srouji, Mark D. Hornstein & Elizabeth S. Ginsburg

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  1. Zachary W. Walker
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  2. Andrea Lanes
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Contributions

Zachary Walker, Andrea Lanes, and Elizabeth Ginsburg contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Zachary Walker and Andrea Lanes. The first draft of the manuscript was written by Zachary Walker and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Zachary W. Walker.

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Conflict of interest

ZW is a contributing author for UptoDate. SS is on the advisory board for Ferring pharmaceuticals. MH is a medical advisory board member for WIN Fertility, Intelon Optics, and contributing author for UpToDate. EG was a medical consultant for Hall-Matson Esq, Teladoc, and CRICO, and is a contributing author for UptoDate.

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Walker, Z.W., Lanes, A., Srouji, S.S. et al. Ultra-low–dose and very-low–dose Lupron downregulation protocols for poor responders based on POSEIDON group 3 and 4 classifications. J Assist Reprod Genet 40, 1881–1895 (2023). https://doi.org/10.1007/s10815-023-02842-8

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