Agonist hold Antagonist Protocol versus Antagonist Protocol in Intracytoplasmic Sperm Injection for Infertile Patients with Polycystic Ovary Syndrome

Introduction Polycystic Ovary Syndrome (PCOS) is the most common endocrinopathy in reproductive-aged women in the United States, affecting around 7% of women. Although the specific cause of PCOS is unknown, it is assumed to be caused by a complex interplay of hereditary and environmental factors. Changes in luteinizing hormone (LH) action, insulin resistance, and a probable propensity to hyperandrogenism have all been related to the pathophysiology of PCOS (Dafopoulos et al., 2009). The importance of ovarian stimulation in the success of in vitro fertilization and embryo transfer (IVF-ET) treatment has long been recognised. As a result, since the 1980s, a gonadotropin releasing hormone (GnRH) agonist protocol has been created and used in the context of IVF-ET treatment. By desensitising pituitary receptors, the GnRH agonist regimen is aimed to restrict the release of pituitary follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (Huirne et al., 2007). The introduction of a GnRH antagonist regimen, which blocks pituitary receptors, has recently provided another option for ovarian stimulation. The use of a GnRH antagonist strategy has been shown to minimize the length of the ovulatory stimulu sand the occurrence of ovarian hyperstimulation syndrome. The shorter time of analogue medication, the shorter duration of FSH stimulation, and the lesser chance of developing ovarian hyperstimulation syndrome (OHSS) are all advantages of antagonists (Al-Inany et al. ,2016). Because the GnRH antagonist protocol is straightforward, convenient, and flexible, and because it does not cause functional ovarian cysts or "menopausal" symptoms like the agonist protocol, many doctors and patients like it. However, results from randomised clinical trials show that the antagonist protocol retrieves fewer oocytes and has lower pregnancy rates than the agonist long treatment (Kim CH et al., 2011). Abstract Background: Polycystic Ovary Syndrome (PCOS) is currently thought to emerge from a complex interaction of genetic and environmental traits.Polycystic Ovary Syndrome is the most common endocrinopathy among reproductive-aged women Objectives: The aim of this study was to compare between agonist hold antagonist protocol and antagonist protocol in ICSI for Infertile patients with PCOs as regard the number of oocytes retrieved, fertilization rate, implantation rate and clinical pregnancy rate. Patients and methods: This was a prospective comparative study, which was conducted at Assisted Reproduction Unit at Qena University Hospital.This work had been conducted on infertile women with PCOS undergoing ICSI in ART unit in obstetrics and gynecology department, Qena University hospital from January 2019 to June 2020. Results: The number of implanted embryos was significantly higher in agonist hold antagonist protocol group compared to antagonist protocol group (p<0.001).Also, clinical pregnancy was found to be significantly higher in agonist hold antagonist protocol group compared to antagonist protocol group (p=0.009). On the other hand, prevalence of OHSS was significantly higher in antagonist protocol group compared to agonist hold antagonist protocol group (p=0.023).There was no statistically significant difference between the two groups regarding β-HCG (p>0.05). Conclusion: GnRH agonis thold antagonist may be a preferred protocol for PCOS patients treated with ICSI in view of the reduction of the risk of OHSS, the shorter stimulation time and better pregnancy outcome.