Fatehi Hanieh, Davar Robab, Nikfarjam Elham, Bayati Fatemeh
Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Gynecology and Infertility Department, Shiraz Fertility Center, Shiraz, Iran.
Int J Reprod Biomed. 2024 Oct 14;22(8):617-626. doi: 10.18502/ijrm.v22i8.17230. eCollection 2024 Aug.
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.
This study aims to assess the treatment outcomes of flexible and fixed types of GnRH-antagonist protocol for IVF in women with PCOS.
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 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.
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.
In conclusion, the IVF outcomes are more favorable in women with PCOS undergoing the flexible GnRH-antagonist protocol compared to the fixed protocol.
尽管促性腺激素释放激素（GnRH）拮抗剂方案在治疗不孕女性，尤其是多囊卵巢综合征（PCOS）患者中广泛应用，但尚无足够证据比较体外受精（IVF）周期中灵活型和固定型方案的差异。
本研究旨在评估灵活型和固定型GnRH拮抗剂方案用于PCOS女性IVF的治疗结局。
在这项随机临床试验中，纳入了2023年10月至2〇24年2月期间转诊至伊朗亚兹德不孕研究与临床中心、符合IVF条件的150例PCOS不孕女性。根据拮抗剂方案类型（固定型或灵活型）将参与者分为2组（每组n = 75）。固定组在促性腺激素治疗第5天开始使用GnRH拮抗剂。灵活组在至少有一个卵泡直径达12 - 14mm时开始使用GnRH拮抗剂。最后，评估中期II卵母细胞数量、胚胎质量、刺激周期时长、促性腺激素剂量、GnRH拮抗剂使用次数及卵巢过度刺激综合征发生率。
两组在周期长度和促性腺激素总剂量方面未观察到统计学显著差异。然而，与固定组相比，灵活组的卵母细胞总数（17.84对15.5，p = 0.023）和成熟卵母细胞数（13.64对11.83，p = 0.019）有显著差异。
总之，与固定方案相比，PCOS女性采用灵活型GnRH拮抗剂方案进行IVF的结局更优。
