Efficacy of Stop GnRH-Agonist/Antagonist versus GnRH-Antagonist Protocols in In Vitro Fertilization Cycles of Patients with Polycystic Ovary Syndrome: A Pilot Randomized Controlled Trial.

Background: fertilization (IVF) procedure to enhance oocyte retrieval and embryo generation. This study aims to compare the efficacy of the stop gonadotropin hormone-releasing hormone agonist (GnRH-agonist)/GnRH-antagonist protocol versus the conventional GnRH antagonist protocol in PCOS patients undergoing IVF. Materials and Methods: A pilot randomized controlled trial was conducted from March to December 2023 at ValiE-Asr Hospital, Tehran. Forty PCOS patients were randomized into two groups: stop GnRH-agonist/GnRH-antagonist (n=20) and conventional GnRH antagonist (n=20). Participants' demographics, hormonal profiles, and treatment outcomes were recorded. The primary outcome was the number of mature oocytes retrieved; secondary outcomes included the number of follicles >12 mm on human chorionic gonadotropin (hCG) administration day and ovarian hyperstimulation syndrome (OHSS) incidence. Data was analyzed using SPSS 21.0, employing t tests, Mann-Whitney tests, and Chi-square tests as appropriate. Results: Baseline characteristics were similar between groups. The conventional protocol group had significantly more 16-18 mm follicles but no differences in total oocytes retrieved, metaphase 1 and 2 oocytes, or degenerated oocytes. Stimulation duration was shorter in the conventional group. No significant differences were observed in OHSS incidence or total gonadotropin dose. Conclusion: The Stop GnRH-agonist/GnRH-antagonist protocol is a viable alternative for PCOS patients, offering comparable oocyte yields and safety profiles to the conventional GnRH antagonist protocol. Larger studies are needed to confirm these findings and evaluate long-term outcomes such as pregnancy and live birth rates (registration number: IRCT20180409039247N10).