Short GnRHa (“Microflare” Protocols
Another approach to COH is by way of so-called “microflare protocols.” This involves
initiating gonadotropin therapy simultaneous with the administration of GnRH agonist. The
intent is to deliberately allow GnRHa to effect an initial surge (“flare”
in pituitary FSH
release so as to augment ovarian response to the gonadotropin medication. Unfortunately,
this approach represents “a double-edged sword” as the resulting increased release of FSH is
likely to be accompanied by a similar rise in blood LH levels that could evoke excessive
ovarian stromal androgen production. The latter could potentially compromise egg quality,
especially in women with diminished ovarian reserve (often older women) and in women
whose ovaries have increased sensitivity to LH like those with polycystic ovarian syndrome
(PCOS). We believe that in this way, “microflare protocols” could potentially have a
negative impact upon endometrial development, compromise egg/embryo quality, and reduce
IVF success rates. Accordingly, we prefer to avoid “flare protocols”.