Comparative Study of Agonist versus Antagonist Protocols in Patients with Polycystic Ovary Syndrome: A Cross‑Sectional Study

Abstract

Polycystic ovary syndrome (PCOS) is a prevalent endocrinopathy affecting 5–10% of reproductive-age women, frequently necessitating controlled ovarian stimulation via GnRH analogues to mitigate the risk of premature luteinizing hormone surges. The study aims to compare the efficacy of the fixed Gonadotropin-Releasing hormone (GnRH) antagonist protocol vs. the GnRH agonist protocol in patients with polycystic ovary syndrome undergoing ICSI. A cross-sectional study was conducted among 158 PCOS patients at the Benghazi Teaching Hospital for Fertility and Assisted Reproduction. A statistically significant difference was observed in the duration of stimulation, which was found to be significantly longer in the agonist protocol compared to the antagonist protocol (10±2 vs 9.3±1.6, p = 0.0005). There is no significant difference between both groups in view of the dose of gonadotropin drugs (26.7 ± 8.5in agonist group vs. 25.3 ±10 in antagonist group), pregnancy outcome (17% agonist group vs.14.3% antagonist group with p = 0.403 ). A statistically significant difference was observed in the number of MII oocytes; the agonist protocol had a higher number (p = 0.028). The antagonist protocol was associated with a significantly higher incidence of empty follicles compared to the agonist protocol (p = 0.032). While both protocols yielded identical pregnancy rates and similar safety profiles regarding OHSS, the GnRH Agonist protocol appeared more favorable in this specific study due to lower cancellation rates and fewer empty follicles.