Comparison between gnrh agonist long protocol and GnRH antagonist protocol in IVF-ICSI-ET cycles of infertile patients having normal ovarian reserve

Comparison between GnRH Agonist Long Protocol and GnRH Antagonist Protocol in IVF-ICSI-ET Cycles of Infertile Patients Having Normal Ovarian ReservePurpose: In this study, we aimed to compare GnRH agonist long protocol and flexible multidose GnRH antagonist protocol for infertile patients having normal ovarian reserve in IVF-ICSI-ET cycles, on which controlled ovarian stimulation was carried out by use of recombinant FSH (rFSH).Material and Method: In our study, medical files belonging to 1765 patients who were subjected to controlled ovarian stimulation (KOS) by use of recombinant FSH and afterwards to IVF-ICSI-ET in Çukurova University, Faculty of Medicine, Balcalı Hospital, Gynecology and Obstetrics Clinic, Assisted Reproduction Center between the dates 1st of January, 2007 and 1st of March, 2010 were retrospectively analyzed. As a result of the examinations on the files, 649 patients were determined to be subjected to GnRH agonist long protocol by use of recombinant FSH, while 249 patients were subjected to flexible multidose GnRH antagonist treatment with recombinant FSH. As a result, a total of 174 patients, 121 of which were subjected to KOS with GnRH agonist long protocol by use of recombinant FSH and 53 of which were subjected to KOS with flexible multidose GnRH antagonistprotocol by use of recombinant FSH, were included in the study. Necessary information were received from the medical files recorded for the patients selected. Afterwards, average values for hCG positive rates, average values for clinic pregnancy (6-7 week fetal heart pulse positive pregnancy), average values for discharged newborn rates, average total FSH stimulation times, average total doses of FSH used, hCG day folliculometry results (number of follicles between 14 and 16 mm and ?17 mm), hCG day estradiol levels, hCG day endometrial thicknesses, obtained oocyst counts, metaphase II oocyst counts, fertilization rates (number of fertilized oocysts / number of ICSI applied oocysts x 100), implantation rates (number of gestational sacs formed / number of transferred embryos x 100) were compared between the two groups.Results: Average total stimulation time for GnRH antagonist protocol group was found to be 8.57±1.26 days, while the same figure was determined to be 9.47±1.56 for the GnRG agonist group (p<0.001). Average total FSH dose applied for the GnRH antagonist protocol was calculated to be 1368.4±271.97 IU, while the same figure was 1474.38±283.53 IU for the GnRG agonist protocol group (p=0.023). Number of follicles equal to or bigger than 17 mm on hCG day was calculated to display a statistically significant difference between the two groups (p=0.007). Average oocyst counts obtained as a result of the treatment was determined to be 6.49±3.97 for the GnRH agonist long protocol and 8.15±4.37 for the GnRH agonist long protocol (p=0.019). Thus, a statistically significant difference is seen to be present between the two groups based on the type of the protocol applied (p=0.019, <0.05). hCG positive rates were 35.8% and 34.7% for the GnRH antagonist group and GnRH agonist group respectively. Rates of newborns discharged to home was observed to be 28.25% for the GnRH antagonist protocol, while it was 27.3% for the GnRH agonist long protocol (p=0.503).Conclusion: As a result of the study conducted, authors of the study determined that the flexible multidose GnRH antagonist protocol used in controlled ovarian stimulation for assisted reproduction techniques provided shorter stimulation period and required less average total FSH dose when compared with the GnRH agonist long protocol. Although follicular development and obtained total number of oocysts were lower, numbers of metaphase 2 oocysts, fertilized oocysts and obtained total number of embryos were observed to be similar between the two groups. Likewise, hCG positve rates, clinic pregnancy rates and rates of newborns discharged to home were similar. In conclusion, flexible multidose GnRH antagonist protocol can be said to provide similar level of effectiveness with the GnRH agonist long protocol.Keywords: Infertile patients having normal ovarian reserve, IVF-ICSI-ET cycles, GnRH agonist long protocol, flexible multidose GnRH antagonist protocol