Fixed versus flexible gonadotropin releasing hormone antagonist protocol in women with polycystic ovary syndrome undergoing in vitro fertilization: An RCT

Background: Despite the extensive use of the gonadotropin-releasing hormone (GnRH) antagonist protocol in treating infertile women, particularly those with polycystic ovary syndrome (PCOS), there have not been sufficient evidence to compare the flexible and fixed variants in in vitro fertilization (IVF) cycles. Objective: This study aims to assess the treatment outcomes of flexible and fixed types of GnRH-antagonist protocol for IVF in women with PCOS. Materials and Methods: In this randomized clinical trial, ۱۵۰ infertile women with PCOS, who were candidates for IVF, and referred to the Yazd Research and Clinical Center for Infertility, Yazd, Iran between October ۲۰۲۳ and February ۲۰۲۴ were included. Participants were divided into ۲ groups (n = ۷۵/each) based on the type of antagonist protocol (fixed or flexible). GnRH antagonist administration started on the ۵th day of gonadotropin treatment in the fixed group. In the flexible group when there was at least one follicle ۱۲-۱۴ mm, GnRH antagonist was started. Finally, the number of metaphase II oocyte, the quality of embryos, the duration of the stimulation cycle, the dose of gonadotropin, the number of GnRH-antagonist, and the rate of ovarian hyperstimulation syndrome were evaluated. Results: No statistically significant difference was observed in terms of cycle length and the total dose of gonadotropin between groups. Nevertheless, a notable distinction was observed in the total number of oocytes (۱۷.۸۴ vs. ۱۵.۵, p = ۰.۰۲۳) and mature oocytes (۱۳.۶۴ vs. ۱۱.۸۳, p = ۰.۰۱۹) in the flexible group compared to the fixed group. Conclusion: In conclusion, the IVF outcomes are more favorable in women with PCOS undergoing the flexible GnRH-antagonist protocol compared to the fixed protocol.

Keywords:

Gonadotropin-releasing hormone , Polycystic ovary syndrome , Fertilization in vitro , Oocytes. , هورمون آزادکننده گنادوتروپین , سندروم تخمدان پلی کیستیک , لقاح آزمایشگاهی , تخمک.