Dual suppression in GnRH antagonist cycles for PCOS patients undergoing ICSI cycles

Abstract

To elucidate weather oral contraceptive pill (OCP) suppression is required or not in GnRH antagonist down regulated ICSI cycles for PCOS patients. Retrospective Cohort Study. Totally 410 PCOS patients with anovulation with/without mild male infertility under 35 years-old undergoing ICSI between 2004 and 2013 were allocated to the study. All data regarding ICSI cycles were statistically compared between 3 subsequent groups; Group A (long luteal GnRH agonist), Group B (GnRH antagonist) and Group C (OCP plus GnRH antagonist). The triggering was made as soon as 3 follicles >17 mm were observed. Groups were comparable in terms of demographic features such as age and BMI. The mean number of stimulation day, cycle cancelation rates due to moderate-severe OHSS and multiple pregnancy rates were all higher in group A than the other groups.Tabled 1The Stimulation and Cycle Outcomes in all GroupsParametersGroup A (n=208)GGroup B (n=143)Group C (n=59)P valueRate of adjuvant mild male Infertility62/208 (29%)40/143 (28%)17/59 (29%)NSCollected MII oocyte(s), n10.2±6.19.3±6.79.5±5.8NSGrade A embryo(s), n4.6±1.94.2±1.94.3±2.2NSStimulation day17±4.3 b,c9.5±2.1 a9.8±2.3 a<0.05Transferred embryo(s), n2.2±0.8 b,c1.7±0.8 a1.7±0.9 a<0.05*Cycle cancellation due to moderate-severe OHSS, The P value has been set at < 0.05 for all groups.Cycle cancelation, (%)5.7 (12/208) b,c1.4(2/143) a1.7 (1/59) a<0.05Multiple pregnancy rates, (%)7.7 (14/208) b,c3.5 (5/41) a3.4(2/59) a<0.05* Cycle cancellation due to moderate-severe OHSS, The P value has been set at < 0.05 for all groups. Open table in a new tab The pregnancy rates were not differs among groups even the mean transferred embryo(s) number was statistically high in group A due to previous common use of GnRH analog regimen before embryo restriction law announced in year 2009. GnRH antagonist regimen should be preferred in PCOS patients min ICSI cycles, however dual suppression with preceding OCP use does not seem to enhance cycle or stimulation outcomes.