Combined Treatment With Gonadotrophin Releasing Hormone Agonist and Gonadotrophins In Poor Responders To Hyperstimulation For In Vitro Fertilization (IVF): Clinical and Endocrine Results

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Abstract
EDITORIAL COMMENT: We believe that this study on gonadotrophin releasing hormone agonist requires comment for our general readers. The emphasis of this journal is on clinical papers but it would be a pity if our general readers passed by reading some of the special aspects of modern endocrinology such as discussed in this paper. The detailed regimens for administration of drugs will mainly interest en-docrinologists, but the general reader should be aware of the application of these recently available hormones and the rationale of their use for stimulation of the ovaries so that oocytes can be collected for in vitro fertilization or intra-Fallopian tube deposition. The authors of this paper were asked, and have provided, the necessary introduction to explain the present indications for the use of gonadotrophin releasing hormone agonist. This paper explains how difficult it has become to improve results in the treatment of infertility in those patients who do not respond to the conventional regimens — it is becoming more expensive in time and money to prise new secrets from Nature on the control of the process of ovulation and conception. Summary: Seventy three cycles of combined gonadotrophin releasing hormone (GnRH) agonist/gonadotrophin treatment for IVF controlled ovarian hyperstimulation in previous poor responders to standard ovarian hyperstimulation therapy are reported. Oocyte numbers obtained were better than the previous average results, but were similar to the previous best response. In general more oocytes than the previous mean could be expected but low order responders were not transformed into high order responders. Pregnancies did occur in this difficult group of patients but the rate was modest. Because of a reduction in cancelled cycles, patients might reduce their total costs in time and gonadotrophin used, however this treatment is not a panacea for the true low order responder.