Gonadotropin Releasing Hormone Agonists versus Antagonists in Women with Polycystic Ovary Disease Undergoing Intracytoplasmic Sperm Injection

Abstract

Introduction: Polycystic ovary syndrome (PCOS) is one of the most important endocrine disorders that cause infertility in young women. Recent meta-analyses have reported that treatment success with GnRH antagonists and GnRH agonists was similar. But no studies are available to determine which protocol is the best in the PCOS patient group. Aim: To compare the Intracytoplasmic Sperm Injection (ICSI) outcome of Gonadotropin Releasing Hormone Agonists (GnRHa) to antagonists (GnRHant) in women with polycystic ovary disease. Materials and Methods: In this retrospective cohort study; out of 3000 patients, 144 women were enrolled who met the inclusion criteria for polycystic ovary disease, according to the Rotterdam criteria at the In-Vitro Fertilization Unit. Cases with GnRHa used for controlled ovarian hyperstimulation (n=95) were compared to cases with GnRHant use (n=49). All analyses were performed using the Statistical Package for Social Sciences software, version 15.0 for Windows. The variables were compared to Pearson Chi-Square and Fisher’s-Exact Tests in 2×2 eyes. Normally distributed (parametric) variables were evaluated between groups, whereas Independent groups were compared using t-test. Results: The mean age, infertility period, FSH level, body mass index and the mean number of embryos transferred were similar in both groups (p>0.05). The average dose of FSH was significantly lower in Group 2 (1765±624 IU) compared to Group 1 (2535±838 IU, p<0.001). The rate of cycle cancellation due to ovarian hyperstimulation risk was 6.4% in group 2, which was similar to the 15.2% in group 1 (p=0.13). The cleavage rate (Group 2; 49.1±22.2%, Group 1; 64.2±24.4%, p=0.001), fertilization rate (Group 2; 48.7±21.5%, Group 1; 63.2±21.5%, p=0.001) and the mean number of good quality embryos transferred (Group 2; 2.5±0.2, Group 1; 2.9±0.8, p=0.02) was significantly lower in group 2 compared to group 1. The clinical pregnancy rate was 30% in group 2 compared to 34.1% in group 1 (p=0.6). The live birth rate was 22.5% in group 2 and 25% in group 1 (p=0.7). Conclusion: Similar clinical pregnancy outcomes can be achieved in GnRH antagonist cycles using lower gonadotropin doses compared to GnRH agonist cycles.

Keywords

• gnrh antagonist
• gnrh agonists
• polycystic ovary syndrome
• pregnancy outcome