With the widespread use of gonadotropin-releasing hormone agonist
(GnRH-a) for in vitro fertilization(IVF) program, the cancellation rate during controlled
ovarian hyperstimulation(COH} is much lowered. However, poor responders with poor
estradioI(E2} rise or single dominant follicle still persist in GnRH-a combined COH,
and the decision to cancel the cycle and the counselling of further cycles remain very
perplexing. Three poor responders with single dominant follicle during GnRH-a
combined COH for IVF were, rather than being cancelled, managed by continuous
administration of GnRH-a and restimulation with initial low dosage and subsequent
high dosage of follicle-stimulating hormone until an appropriate number of follicles was
obtained. While no pregnant case treated in this way, the management resulted in a
higher E2 level, and more oocytes and embryos. We suggest that this approach could
serve as an alternative to cancellation in GnRH-a combined COH
