Gnrhagonist versus GNRH Antagonist in IVF: A Comparison of Ovarian Hyperstimulation Syndrome in Infertile Females

Abstract

Objective: To compare the frequency of ovarian hyperstimulation syndrome in infertile females with GnRH agonists versus GnRH antagonists seeking invitro fertilization

Study design: A prospective cohort study

Settings and duration: At Obstetrics and Gynecology Department of Arif Memorial Teaching Hospital  Lahore, from 14^th March 2024 to 14^th March 2025.

Methods: A total of 60 infertile women aged 20-40 years referred for the first IVF/ ICSI were selected for the study, using non-probability, consecutive sampling.Women were divided into two groups: Group A and Group B. Patients in Group A were 30 women administered 500 µg GnRH agonist (Buserelin) subcutaneously every day since the 21st day of the menstrual cycle. The dose was reduced by 300 µg on the 2nd day of the cycle after pituitary suppression, and 150 µg gonadotropin was added to the regimen. Patients in Group B were 30 women administered 0.25 mg GnRH antagonist (Cetrotide) subcutaneously. 150 IU Pregonal was administered intramuscularly from the third day.After ovum retrieval,if more than three follicles had estradiol greater than 3000 pg/ml at 3 months and 6 months, it was described as OHSS, which was managed by standard procedure

Results: The frequency of primary infertility patients in Group A was 16 (53.3%), and secondary infertility was 14(46.7%). The frequency of primary infertility patients in GroupB was 19(63.3%), and secondary infertility was 11(36.7%). The mean number of mature follicles of patients in GroupA was 14.4±1.27 (1-35). The mean number of mature follicles of patients in GroupB was 13.6±1.24 (2-27). The mean E2 level in patients of GroupA was 3261.8±134.7 (Range: 1008-4215) and the mean E2 level in patients of GroupB was 3500±167.4 (Range: 1000-4890). The frequency of patients with ovarian hyperstimulation syndrome in GroupA was 2 (6.7%) and in GroupB was 8 (26.7%).

Conclusion: GnRH agonist is more effective than GnRH antagonist in terms of frequency of ovarian hyperstimulation syndrome in infertile women seeking invitro fertilization.