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Background <p>Poor ovarian reserve is a challenge in IVF cycles. How to get the optimum response for a given stimulation protocol is always a question that needs to be answered.</p> Purpose of the study <p>This study investigates the efficacy of the MARC-modified microflare-up Gonadotropin Releasing Hormone (GnRH) agonist protocol in POSEIDON group 3 and group 4, focusing on its impact on various indices of ovarian response and pregnancy outcomes. Despite the challenges presented by poor ovarian reserve (POR), our research evaluates whether this protocol can deliver consistent results irrespective of age, antral follicle count (AFC), or anti-Müllerian hormone (AMH) levels, Using metrics such as the Follicular Output Rate (FORT), Follicle-to-Oocyte Index (FOI), and Oocyte Sensitivity Index (OSI), we compared outcomes between the two groups.</p> Methods <p>Women with an Anti-Müllerian Hormone (AMH) ≤ 1.5&#xa0;ng/mL or an Antral Follicle Count (AFC) ≤ 5 were recruited for the MARC-modified microflare protocol. Modification of the standard micro flare protocol was by avoiding the pre-treatment COC. Eight patients were excluded from the analysis due to cycle cancellation (11.7%) resulting from nonresponse to stimulation. The remaining 60 patients were included for evaluation and grouped into four according to POSEIDON criteria.</p> Results <p>Eight of the 68 women enrolled were excluded due to cycle cancellation, resulting in a final analysis of 60 women, with 28 in Group A (POSEIDON 3) and 32 in Group B (POSEIDON 4).FORT, FOI, and OSI in both groups were comparable, suggesting the effectiveness of the stimulation protocol. Importantly, the study highlights that age is not a limiting factor in the effectiveness of the MARC-modified microflare protocol. The protocol consistently facilitated a favorable ovarian response regardless of age, AFC, or AMH levels. Key measures, including biochemical and clinical pregnancy rates, showed no significant differences, demonstrating the protocol’s uniform effectiveness.</p> Conclusion <p>MARC-modified microflare-up GnRH agonist protocol proves to be an effective and versatile option for ovarian stimulation in POR patients. Delivering consistent outcomes across varied patient profiles offers a robust solution for managing POR, reinforcing the notion that age is merely a number in the context of ovarian stimulation efficacy in POSEIDON groups 3 and 4.</p>

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AGE is just a Number: MARC-Modified Microflare GnRH Agonist Protocol Shows Equal Effectiveness Across POSEIDON Groups 3 and 4

  • 期刊论文

  • 发表日期：

    2025年10月30日

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  • Pooja Adiga,
  • Anjali Mundkur,
  • Vidyashree G. Poojari,
  • Prashanth Adiga,
  • Pratap Kumar,
  • Shubha Rao,
  • Rashmi Ullagaddi

摘要

Background

Poor ovarian reserve is a challenge in IVF cycles. How to get the optimum response for a given stimulation protocol is always a question that needs to be answered.

Purpose of the study

This study investigates the efficacy of the MARC-modified microflare-up Gonadotropin Releasing Hormone (GnRH) agonist protocol in POSEIDON group 3 and group 4, focusing on its impact on various indices of ovarian response and pregnancy outcomes. Despite the challenges presented by poor ovarian reserve (POR), our research evaluates whether this protocol can deliver consistent results irrespective of age, antral follicle count (AFC), or anti-Müllerian hormone (AMH) levels, Using metrics such as the Follicular Output Rate (FORT), Follicle-to-Oocyte Index (FOI), and Oocyte Sensitivity Index (OSI), we compared outcomes between the two groups.

Methods

Women with an Anti-Müllerian Hormone (AMH) ≤ 1.5 ng/mL or an Antral Follicle Count (AFC) ≤ 5 were recruited for the MARC-modified microflare protocol. Modification of the standard micro flare protocol was by avoiding the pre-treatment COC. Eight patients were excluded from the analysis due to cycle cancellation (11.7%) resulting from nonresponse to stimulation. The remaining 60 patients were included for evaluation and grouped into four according to POSEIDON criteria.

Results

Eight of the 68 women enrolled were excluded due to cycle cancellation, resulting in a final analysis of 60 women, with 28 in Group A (POSEIDON 3) and 32 in Group B (POSEIDON 4).FORT, FOI, and OSI in both groups were comparable, suggesting the effectiveness of the stimulation protocol. Importantly, the study highlights that age is not a limiting factor in the effectiveness of the MARC-modified microflare protocol. The protocol consistently facilitated a favorable ovarian response regardless of age, AFC, or AMH levels. Key measures, including biochemical and clinical pregnancy rates, showed no significant differences, demonstrating the protocol’s uniform effectiveness.

Conclusion

MARC-modified microflare-up GnRH agonist protocol proves to be an effective and versatile option for ovarian stimulation in POR patients. Delivering consistent outcomes across varied patient profiles offers a robust solution for managing POR, reinforcing the notion that age is merely a number in the context of ovarian stimulation efficacy in POSEIDON groups 3 and 4.