The Clinical Significance of A Low Percentage of Mature Oocytes Retrieved Using Common Ovarian Stimulation Protocols. - The Clinical Significance of A Low Percentage of Mature Oocytes Retrieved Using Common Ovarian Stimulation Protocols. - Open Access Pub

The objective of this study was to investigate whether percentage of mature oocytes retrieved from ovaries stimulated with long agonist or multi-dose antagonist protocols affect the implantation, clinical pregnancy and live birth of ICSI (Intracytoplasmic sperm injection) cycles. The 654 cycles of agonist (long lupron) and 610 cycles of multi-dose flexible antagonist (antagon) were analyzed after stratification according to the percentage of the mature oocytes retrieved. The clinical pregnancy of the groups with less than 30 % mature oocytes retrieved, both antagonist and agonist protocol was statistically lower (at least p< 0.05) compared to the groups with more than 30% mature oocytes retrieved. In the agonist protocol, the implantation and live births for this group were significantly (p<0.009) lower than in the group with ≥70% mature oocytes retrieved. The live births in groups with more mature oocytes retrieved (30-69% and ≥70 %) of the antagonist protocol were lower (22.2% vs. 35.9% and 23.9% vs. 41.5%, p<0.0001, respectively) compare to the agonist protocol. The results of our study showed that a very low percentage of mature oocytes retrieved impacts the clinical outcome of antagonist and long agonist protocols. DOI 10.14302/issn.2576-2818.jfb-17-1435 Since the early 1980’s a variety of controlled ovarian hyperstimulation (COH) protocols with the use of gonadotrophin-releasing hormone (GnRH) analogues (agonists or antagonists) in conjunction with gonadotropins/menotropins have been developed 1, 2, 3, 4. The addition of GnRH analogues significantly reduced the incidence of premature LH surges and cycle cancellations, leading to a higher number of oocytes retrieved, with an improved outcome of infertility treatments 5, 6, 7, 8. Despite a significant number of studies 3,12,13,31,34,38,40,42,48,52 comparing both long GnRH agonist and GnRH antagonist protocols, the superiority of one over another is still widely debated in the literature. The mechanism of action of these two analogues (agonist and antagonist) is different. In the long agonist protocol, antral follicles are recruited by exogenous gonadotropin after early depletion of endogenous hormones. In the antagonist protocol the endogenous hormones recruit follicles. GnRH antagonist controls gonadotropin secretion by its immediate suppression in the pituitary. The use of the antagonist is associated with a shorter time of stimulation, reduced gonadotropin consumption and a reduced ovarian hyper-stimulation incidence (OHSS) as well as a different pattern of steroid hormones concentration in the