Early Initiation of Gn RH Antagonist versus long agonist Protocols in PCOS Patients Undergoing ICSI Cycles.

Abstract

AbstractPurpose: To compare the efficacy of early initiation of Gonadotrophin Releasing Hormone (GnRH) antagonist in comparison with the GnRH agonist protocol in Polycystic Ovarian Syndrome (PCOS) patients undergoing Intracytoplasmic Sperm Injection (ICSI) cycles. Materials and methods: Prospective randomized controlled trial. Seventy infertile PCOS patients under 35 years of age coming for the first trial IVF/ICSI treatment at the infertility care unit were included in the study. They were randomized to either GnRH agonist long protocol (control group A) or early initiation of GnRh antagonist (study group B) after pretreatment with OCP. Ovulation was triggered with Humman Chorionic Gonadotrophin (hCG) when at least 3 mature follicles 18 mm were detected. Results: Age, body mass index, duration of infertility, basal Follicle Stimulating Hormone (FSH), Lutinizing Hormone (LH), Estradiol (E2) at the first day of the cycle, the number of oocytes retrived, the total number of embryos, chemical, clinical pregnancy and implantation rates were comparable in both groups and there was no statistically significant difference. The stimulation period was shorter in group B than group A and number of ampoules of gonadotrophins ampoules and Serum E2 level on the day of hCG administration were significantly lower in group B than that of the group A with statistically significant differences. Moderate OHSS was documented in 4 cycles of group A but was not in any cycle of group B and this difference was statistically significant. No cases of severe OHSS were documented in both groups.Conclusions: This novel antagonist protocol may be a safe and efficient treatment for PCOS patients undergoing ICSI cycles with comparable results to the standard long GnRH agonist protocol.