Comparative Efficacy of GnRH Agonist and Antagonist Protocols in Managing Poor Ovarian Reserve

Infertility has a significant impact on the quality of life of both men and women. As women in modern times tend to bear children at older age, the average age of first-time mothers is rising in several countries. One significant barrier to the effectiveness of any treatment for infertility and childbirth is poor ovarian reserve (POR). While diminished ovarian reserve (DOR) is indicated by low anti-müllerian hormone (AMH) levels or low antral follicle count (AFC), indicating that only a limited number of oocytes can be retrieved in a single stimulation cycle. Clinicians face challenges in selecting the appropriate treatment protocol for patients with low ovarian reserve, whether to use an agonist or antagonist, to promote multiple follicle development and achieve clinical pregnancy.

The current study was hypothesized to identify an accurate protocol in patients with poor ovarian reserve to enhance reproductive outcomes. The study enrolled women aged 25-40 over a period of one year attending the ART clinic eligible for IVF/ICSI. They were randomized into two groups: Group A, which follows the long-acting GnRH agonist protocol, and Group B, which follows the GnRH antagonist protocol. Only Grade A/B embryos of Day 3 and Day 5 were transferred in patients.

The findings of the study revealed:

• No significant differences were found between the two groups in the number of oocytes retrieved, M2 oocytes, total embryos formed, or Day 3 and Day 5 embryos. 
• The duration of stimulation was similar, but the total dose of gonadotropins was higher in the long-acting GnRH agonist group.
• Although the number of good-quality Day 3 embryos (Grade A/B) was higher in the agonist group, this difference was not statistically significant.
• The clinical pregnancy rate was also higher in the agonist group, but the difference was not statistically significant.

The study concluded that both long-acting GnRH agonist and GnRH antagonist protocols have similar efficiency for patients with POR. However, due to the limited quality and quantity of oocytes in these patients, an ideal treatment protocol has yet to be identified.

Source: Chopra S, Hooda R, Devi GM. Optimizing in vitro fertilization outcomes: Long-acting gonadotrophin releasing hormone agonist versus gonadotrophin releasing hormone antagonist protocol in Poseidon groups 3 and 4. Int J Clin Obstet Gynaecol 2024;8(6):17-21. DOI: 10.33545/gynae.2024.v8.i6a.1532