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

IF 1.6 Q3 OBSTETRICS & GYNECOLOGY International Journal of Reproductive Biomedicine Pub Date : 2024-10-14 eCollection Date: 2024-08-01 DOI:10.18502/ijrm.v22i8.17230
Hanieh Fatehi, Robab Davar, Elham Nikfarjam, Fatemeh Bayati
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Abstract

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, 150 infertile women with PCOS, who were candidates for IVF, and referred to the Yazd Research and Clinical Center for Infertility, Yazd, Iran between October 2023 and February 2024 were included. Participants were divided into 2 groups (n = 75/each) based on the type of antagonist protocol (fixed or flexible). GnRH antagonist administration started on the 5 th day of gonadotropin treatment in the fixed group. In the flexible group when there was at least one follicle 12-14 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 (17.84 vs. 15.5, p = 0.023) and mature oocytes (13.64 vs. 11.83, p = 0.019) 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.

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多囊卵巢综合征妇女体外受精中促性腺激素释放激素拮抗剂固定方案与灵活方案的比较:一项 RCT 研究。
背景:尽管促性腺激素释放激素(GnRH)拮抗剂方案被广泛用于治疗不孕妇女,尤其是多囊卵巢综合征(PCOS)妇女,但在体外受精(IVF)周期中,还没有足够的证据对灵活型和固定型方案进行比较:本研究旨在评估在多囊卵巢综合征(PCOS)妇女的体外受精中,灵活型和固定型GnRH-拮抗剂方案的治疗效果:在这项随机临床试验中,共纳入了 150 名患有多囊卵巢综合征的不孕女性,她们都是体外受精的候选者,并在 2023 年 10 月至 2024 年 2 月期间转诊至伊朗亚兹德的亚兹德不孕症研究与临床中心。根据拮抗剂方案的类型(固定或灵活),参与者被分为两组(每组 75 人)。固定组在促性腺激素治疗的第 5 天开始使用 GnRH 拮抗剂。在灵活组中,当至少有一个卵泡长到 12-14 mm 时,就开始使用 GnRH 拮抗剂。最后,对 II 期卵母细胞的数量、胚胎质量、刺激周期的持续时间、促性腺激素的剂量、GnRH-拮抗剂的使用次数以及卵巢过度刺激综合征的发生率进行了评估:结果:在周期长度和促性腺激素总剂量方面,各组之间没有发现明显的统计学差异。然而,在卵母细胞总数(17.84 对 15.5,p = 0.023)和成熟卵母细胞数(13.64 对 11.83,p = 0.019)方面,柔性组与固定组相比有明显差异:总之,与固定方案相比,多囊卵巢综合征妇女接受灵活的GnRH-拮抗剂方案进行试管婴儿的结果更理想。
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来源期刊
CiteScore
2.40
自引率
7.70%
发文量
93
审稿时长
16 weeks
期刊介绍: The International Journal of Reproductive BioMedicine (IJRM), formerly published as "Iranian Journal of Reproductive Medicine (ISSN: 1680-6433)", is an international monthly scientific journal for who treat and investigate problems of infertility and human reproductive disorders. This journal accepts Original Papers, Review Articles, Short Communications, Case Reports, Photo Clinics, and Letters to the Editor in the fields of fertility and infertility, ethical and social issues of assisted reproductive technologies, cellular and molecular biology of reproduction including the development of gametes and early embryos, assisted reproductive technologies in model system and in a clinical environment, reproductive endocrinology, andrology, epidemiology, pathology, genetics, oncology, surgery, psychology, and physiology. Emerging topics including cloning and stem cells are encouraged.
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