Comparison of outcomes in terms of number and quality of oocytes, embryos, and pregnancy rate in pretreatment and non-pretreatment groups in gnrh antagonist protocol in IVF – A cohort study.

Shubhanti  Kumari; Bhawana  Tiwary; Kalpana  Singh; Niharika; Sangeeta  Kumari

doi:10.51168/sjhrafrica.v6i6.1823

Authors

Shubhanti Kumari Associate Professor, Department of Reproductive Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Bhawana Tiwary Associate Professor, Department of Reproductive Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Kalpana Singh Professor & HOD, Department of Reproductive Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Niharika Senior Resident, Department of Reproductive Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
Sangeeta Kumari Chief Embryologist, Department of Reproductive Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i6.1823

Keywords:

IVF, GnRH antagonist, pre-treatment, oocyte quality

Abstract

Background: The GnRH antagonist protocol in IVF offers a patient-friendly approach with reduced treatment duration. However, follicular asynchrony remains a concern due to the inherent FSH sensitivity during the late luteal phase, potentially affecting IVF outcomes.

Aim: To compare the outcomes of pre-treatment versus non-pre-treatment groups in GnRH antagonist IVF cycles in terms of gonadotropin consumption, oocyte and embryo quality, and pregnancy rates.

Materials and Methods: This prospective observational study included 130 subfertile women undergoing IVF at IGIMS, Patna, randomized into pre-treatment (n=65) and non-pre-treatment (n=65) groups. Synthetic progestogens were administered in the pre-treatment group. Controlled ovarian hyperstimulation was conducted using recombinant FSH, with GnRH antagonist initiated when follicles reached 14 mm.

Results: The average Antral Follicle Count (AFC) in the non-pre-treatment group was 16.10 ± 4.98, while the pre-treatment group had an AFC of 15.70 ± 5.01. The difference between the two groups was not statistically significant (p = 0.667). Similarly, Anti-Müllerian Hormone (AMH) levels, gonadotropin dose, stimulation duration, and number of mature oocytes retrieved showed no significant differences between the groups. The pregnancy rate in the pre-treatment group was 46.15%, compared to 44.62% in the non-pre-treatment group. This difference was not statistically significant (p = 1.000), indicating that pre-treatment did not lead to improved pregnancy rates.

Conclusion: Pre-treatment with progestogens in GnRH antagonist IVF protocols does not improve clinical outcomes, suggesting that routine pre-treatment may not be necessary in normal responders. Pre-treatment may help synchronise follicles and schedule cycles, but it does not increase reproductive outcomes.

Recommendation: A larger cohort would allow for more robust statistical analysis and might uncover additional nuances in the relationships between laboratory parameters and clinical outcomes.

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