A novel ovarian stimulation protocol with gonadotropin- releasing hormone (GnRH) antagonist and follicle stimulating hormone from cycle day 1 in IVF in patients with polycystic ovary syndrome (PCOS)

Abstract

OBJECTIVE: Theoretically, administration of GnRH antagonist from first day of cycle would perhaps eliminate the adverse effect of elevated LH in early follicular phase of patients with PCOS. The present study was aimed at investigating the possible beneficial effects of GnRH antagonist along with follicle stimulating hormone from day 1 of IVF cycle in patients with PCOS. DESIGN: Prospective study. MATERIALS AND METHODS: 48 patients were diagnosed to have PCOS, their age ranged between 28-37 years. They had first undergone IVF/ICSI with standard ovarian stimulation protocol using purified FSH in a GnRH long down regulated cycle and had exhibited a very high ovarian response. In the second treatment cycle till date 26 of these patients had undergone ovarian stimulation protocol using highly purified FSH with a starting dose of 75 IU from day 1 of cycle along with GnRH antagonist, cetrorelix (0.25 mg s.c.) daily. GnRH antagonist was continued for first five days of stimulation; re-administered from the day when lead follicle measured 13 to 14 mm diameter and was continued till the day of hCG administration. RESULTS: The number of ampoules used, the estradial level on the day of hCG and the number of oocytes were significantly lower with this novel antagonist protocol as compared to the long GnRH agonist protocol. Follicular growth uniformity was also superior in antagonist group. Four patients suffered with OHSS in the standard agonist protocol and none with this antagonist protocol. High implantation (23%) and clinical pregnancy (10 out of 24; 41.2%) were obtained in this antagonist protocol. CONCLUSIONS: This novel antagonist protocol offers a safe low cost and efficient treatment for patients who present with polycystic ovaries syndrome who are at high risk of ovarian hyperstimultion syndrome (OHSS) to standard IVF stimulation protocols. Based on the high implantation and pregnancy rate documented in this novel antagonist protocol, it is tempting to speculate that administration of GnRH antagonist during cycle day 1 to cycle day 5 and again from the day when lead follicle measures 13-14 mm, might optimize the controlled ovarian stimulation protocol in IVF/ICSI in patients with PCOS who are at high risk of OHSS.