 Recently, GnRH antagonists have also been shown to coordinate follicular size and subsequent growth when used in the luteal phase of the preceding menstrual cycle 12,13. Dragesic et al. 13 developed a novel protocol for poor responders which incorporated both transdermal estradiol E2and GnRH antagonist use in the luteal phase, followed by gonadotropin stimulation in the follicular phase and the addition of a GnRH antagonist in the late follicular phase. From this point on, this protocol will be referred to as the Luteal Phase Ganirelix LPG Protocol. During the LPG protocol, subjects applied a 0.1 mg transdermal estradiol patch on the 10th day after the LH surge and replaced this patch with a fresh 0.1 mg patch every other day. On the second day of patch use, subjects began taking daily ganirelix acetate 0.25 mg subcutaneously for 3 days. Subjects presented for ultrasound on day 2 of menses for FSH, LH, E2 and an ultrasound and stimulation was started per protocol with gonadotropins rFSH and human menopausal gonadotropin HMG. Ganirelix was started when a 13mm follicle was measured on ultrasound, E2 exceeded 300 pgmL, or on cycle day 7. Human chorionic gonadotropin hCG was given for final oocyte maturation and oocyte retrieval was performed 35-36 hours later. All embryo transfers were performed 72 hours after oocyte retrieval. This retrospective study of 68 subjects compared their responses to the LPG protocol with their responses to a prior IVF cycle protocol, which included microdose leuprolide, low-dose leuprolide, and coflare protocols. They found that when patients used the LPG Protocol they had significantly lower cycle cancellation rates, more oocytes retrieved, more mature oocytes, more normally fertilized oocytes, and more embryos available for transfer compared to their prior cycles. Patients did use more gonadotropins during the LPG protocol and had more days of stimulation, although the latter was not statistically significant. 