Abstract

COMPARISON OF THE EFFECTIVENESS OF LONG AGONIST OVER THE ANTAGONIST CONTROLLED OVARIAN HYPER STIMULATION PROTOCOLS IN IN VITRO FERTILIZATION

Manal Taha Al-Obaidy*

Abstract

Background: Infertility is one of the major medical problems in the world caused by genetic or epigenetic factors, or both, which has led to continuous research and advancements in the field of assisted reproductive technology (ART). Many stimulation protocols are available for controlled ovarian hyperstimulation (COH) in in vitro fertilization (IVF). Objective: There is still no agreement, in which protocol of COH is most advantageous in patients of in vitro fertilization treatment. So we compared GnRH antagonist and GnRH long agonist. Methods and subjects: One hundred sixty eight unselected couple were undergoing COH using: 1) GnRH agonist (103 couple), (Decapeptyl® 0.1 mg) administered from day 21 of the preceding mid – luteal phase and continued until the day of HCG injection. Ovarian stimulation was done from day 2 of menstrual cycle - after pituitary desensitization was checked 2) GnRH antagonist (65 couple) using (0.25 mg per day Cetrotide) from the day when the dominant follicle reached a mean diameter ≤ 14 mm until the day of HCG administration. In the stimulation period rFSH daily dose was adjusted individually. Results: The rFSH number of ampoules utilized in GnRH agonist long protocol was significantly higher than that of the GnRH antagonist protocol (26.50 ± 8.98 vs. 23.45 ± 8.5, P=0.041). Similarly, a significant higher estradiol (E2) was noted for the agonist long protocol as compared with that of the antagonist protocol (1711.97 ± 986.31vs. 1251.98 ± 794.98, P=0.047) at the day of HCG administration. Also the endometrial thickness at day of HCG was significantly higher in patients with long agonist protocol compared with antagonist protocol (8.84 ±1.00 vs. 8.54 ± 0.90, P=0.048). More over there was highly significant higher no. of oocyte retrieved by long agonist protocol compared with antagonist protocol (10.63 ± 5.55 vs. 8.08 ± 5.35, P=0.003). However, there was no significant difference in the no. of abnormal, GV and MI oocyte between long agonist and antagonist protocols (0.97 ± 1.75 vs. 0.72 ± 1.55, P=0.338; 0.75 ± 1.11 vs. 0.68 ± 1.15, P=0.705; 0.53 ± 0.99 vs. 0.66 ± 1.73, P=0.576). But on the other hand the long agonist protocol has highly significant higher MII oocyte and fertilized MII oocyte if compared by antagonist protocol (7.88 ± 4.42 vs. 5.58 ± 3.28, P<0.001; 6.02 ± 3.83 vs. ± 2.89, P<0.001). The fertilization rate was higher but not significant in long agonist protocol compared with agonist (77.06 ± 20.89 vs. 73.68 ± 23.84, P=0.350). The number of embryos transferred between the two protocols was highly significant higher in long agonist protocol (4.15 ± 2.15 vs. 3.00 ± 1.70, p<0.001). The long agonist protocol shows significant higher pregnancy rate than antagonist protocols (47.57% vs. 30.77%, P=0.037). Conclusion: GnRH agonist long protocol is better in folliculogenesis and pregnancy rate, which is the imperative goal of COH. Despite its costly and lengthy approach, GnRH agonist long protocol has delivered satisfactory results in most women.

Keywords: IVF, long agonist and antagonist.