Comparison between "short" and "long" protocols in an ICSI programme

Area of Science:

• Reproductive Endocrinology
• In Vitro Fertilization
• Medical Research

Background:

• Controlled ovarian hyperstimulation (COH) is a key component of assisted reproductive technologies.
• Gonadotropin-releasing hormone (GnRH) agonists are widely used to prevent premature luteinizing hormone surges during COH.
• Different administration protocols for GnRH agonists, such as long and short protocols, exist with varying clinical outcomes.

Purpose of the Study:

• To compare the efficacy of GnRH agonist in a long protocol versus a short protocol for COH.
• To evaluate outcomes in patients undergoing intracytoplasmic sperm injection (ICSI) with a history of male factor infertility.
• To determine which GnRH agonist protocol yields better pregnancy rates in this specific patient population.

Main Methods:

• Retrospective study design.
• Inclusion of 424 consecutive patients with male factor infertility undergoing ICSI.
• Categorization of patients into two groups: GnRH agonist long protocol (n=303) and GnRH agonist short protocol (n=121).

Main Results:

• Patients in the short protocol group experienced shorter stimulation times and lower estradiol levels.
• A significantly higher percentage of oocytes were transferred in the long protocol group.
• The clinical pregnancy rate per embryo transfer was significantly higher in the long protocol group (39.3%) compared to the short protocol group (19.2%) (p=0.001).

Conclusions:

• The GnRH agonist long protocol demonstrates superior efficacy in achieving clinical pregnancies per embryo transfer in ICSI programs for patients with male factor infertility.
• The short protocol, while associated with shorter stimulation and lower estradiol levels, resulted in lower pregnancy rates.
• These findings suggest that the long protocol may be a more effective strategy for this patient cohort.