Abstract: Background: Infertility is a disease with profound consequences on the quality of life of both men and women. In modern times as women tend for bearing children at older age, the average age of first-time mothers is increasing in many countries. Poor ovarian reserve (POR) is an important limiting factor for the success of any treatment modality for childbearing and infertility. Low AMH or low AFC is defined as diminished ovarian reserve (DOR) which suggests that only few oocytes will be retrieved from these patients in a single stimulation cycle. It is dilemma in clinical practice for clinicians which protocol to be consider with agonist or antagonist in patients with low ovarian reserve to achieve multiple follicle development and clinical pregnancy. Till now there are not many studies which discuss this valid point. The hypothesis of this study is to discover a perfect protocol in patients with poor ovarian reserve and optimize reproductive outcomes.
Material and Methods: A prospective, randomised controlled study was conducted in a period of one year from 1st July, 2023- 30th June, 2024 at Ridge IVF centre, Delhi. Women of all ages (25-40 years) attending the ART clinic eligible for IVF/ICSI at our centre were randomized using computer generated sequence and assigned in 2 groups: Group A, which follows the long-acting GnRH agonist protocol, and Group B, which follows the GnRH antagonist protocol. Women with age <35 years and S.AMH ≤ 1.2 ng/ml and AFC< 5 (POSEIDON 3) and Age >35 years and S.AMH ≤1.2 ng/ml and AFC< 5 (POSEIDON 4) were included. Only Grade A/B embryos of Day 3 and Day 5 were transferred in patients.
Results: The study showed that that no. of oocytes retrieved, no. of M2 oocytes, no. of total embryos formed, no. of day5 (blastocyst) embryos and no. of day3 embryos formed were similar with statistically no significant difference (p>0.005) in both protocol groups. The duration of stimulation was similar in both groups, but the total dose of gonadotrophins used was higher in Long- acting GnRH agonist protocol (p<0.001) as compared to GnRH antagonist protocol. The study also showed that the good quality embryos (Grade A/B) formed at day3 were higher in agonist group with no statistical significance (p>0.005) while the blastocyst grading (AA/AB/BB) was comparable in both groups. The clinical pregnancy rate was higher in agonist group, but the difference was not statistically significant (p=0.545).
Conclusion: The present study demonstrated that Long-acting GnRH agonist and GnRH antagonist protocols are equally efficient in POR. Due to reduced quality and quantity of oocytes in POR patients, a perfect protocol is still yet to be discovered.
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