|Agonist Versus Antagonist in Intracytoplasmic Sperm Injection Cycles: Which Is The Best?|
|Maanee A.H. Al-Azzam1, Bushra J. Al-Mousawi1, Hayder A. Fawzi2, Balsam Al-Zahawi1|
|1Reproductive Medical Center of Fertility and IVF, Kamal AL-Samaria Hospital, Baghdad, Iraq
2Department of Pharmacy, Al-Esraa University College, Ministry of Higher Education and Scientific
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Keywords : GnRH agonist, GnRH antagonist, pregnancy rate, IVF, ICSI
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Objectives: comparison of Gonadotropin-releasing hormone (GnRH) agonist against GnRH antagonists, regarding pregnancy rate and effect of various predictors on pregnancy outcome.
Materials and Methods: a prospective comparative study involved 189 women undergone intracytoplasmic sperm injection (ICSI) cycles, divided as agonist (107 patients) and antagonist arms (82 patients). The main outcome were chemical and clinical pregnancy rate, other outcomes includes the numbers and quality of Oocyte measurement and pregnancy outcomes.
Results: agonist protocol showed higher rate of pregnancy (32.7%; 95%CI: 23.9 – 42.4%) compared to antagonist protocol (22.0%; 95%CI: 13.6 – 32.5%), with odd ratio [OR] (95%CI) = 1.73 (0.89 – 3.35). Count of retrieved oocytes, count of M2 oocytes, count of fertilized oocytes, count of embryos, and percent fertilized out of total retrieved oocytes was higher in the agonist arm compared to antagonist arm. In multivariate analysis after adjusting for confounders, agonist protocol had higher odds of successful pregnancy compared to antagonist protocol by 57% (partial OR = 1.57, p-value = 0.23).
Conclusion: the agonist protocol offers a favourable outcome in comparison to the antagonist arm, there seems an intrinsic benefit for agonist protocol, which is not explained by the higher number of transferred embryos.
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