 The development of GnRH antagonists led to additional treatment options for poor responders 4. With GnRH antagonist use, suppression in the early follicular phase may be avoided. The GnRH antagonist is then added in the late follicular phase to prevent an LH surge. This protocol may enable a poor responder to recruit more follicles in the early follicular phase and thus have a more optimal response to stimulation. A randomized-controlled multicenter trial comparing the GnRH antagonist ganirelix to a GnRH agonist Buserelin, intranasal preparation in patients using recombinant FSH rFSH showed that ganirelix was safe and well-tolerated 5. They found that the mean duration of stimulation was 1 day shorter in the ganirelix group and that this group used significantly less rFSH. A randomized-controlled clinical trial of poor responders comparing the use of ganirelix to microdose leuprolide acetate GnRH-a in patients undergoing COH for IVF found that the outcomes were similar in both groups 6. There were no differences in total number of days of stimulation, amount of rFSH used, peak estradiol levels, number of oocytes retrieved, fertilization rate, implantation rate, or pregnancy rate. However, this study was limited by a small sample size. Another randomized-controlled trial by Akman et al. 7 compared the use of microdose leuprolide to GnRH antagonist Cetrotide in poor responders undergoing IVF. They found no difference in implantation rates and clinical pregnancy rates but were also limited by a small sample size. 