Ovarian hyper-stimulation protocols in good prognosis patients: Agonist versus Antagonist protocol, an Iraqi view

To elucidate the most appropriate stimulation protocol for intracytoplasmic sperm injection (ICSI) among good prognosis patients.

A cross sectional study including 100 sub-fertile couples with good prognosis profile (women younger than 38 years, with a dose of 1200-3600 IU follicle-stimulating hormone (FSH), retrieving >3 oocytes in their first or second ICSI cycle), were divided into two groups based on stimulation protocol. There were 40 patients treated with GnRH-agonist in group 1 and 60 patients treated with GnRH-antagonist. The total dose of gonadotropins, days of stimulation, endometrial thickness (ET), estradiol (E2) at the day of human chorionic gonadotropin hCG, ICSI outcome, ovarian hyperstimulation syndrome (OHSS) and pregnancy rate were analyzed and compared between the two groups.

The study showed that in comparison with the GnRH-agonist stimulation protocol, the GnRH-antagonist stimulation protocol resulted in less use of gonadotropins, more retrieval of oocytes, lower risk of OHSS and higher pregnancy rate in good prognosis patients (1890.00 ± 143.81 vs 1572.50 ±111.67, 10.25 ±1.13 vs 11.17±1.21 and 20% vs 10%, 45% vs 53.3%) respectively but without significant differences (P-value > 0.05).

The GnRH-antagonist stimulation protocol is as effective as the GnRH-agonist stimulation protocol for good prognosis patients.