Fixed Versus Flexible Antagonist Protocol in Reduced Ovarian Reserve Patients: A Historical Cohort Study

The antagonist of gonadotropin-releasing hormone is proven to be effective and safe in preventing a surge in luteinizing hormone (LH) during in vitro fertilization (IVF) cycles. In addition, the differentiation of GnRH antagonist protocols is in timing the initiation of the GnRH antagonist. The present study aimed to compare fixed versus flexible antagonist regimens in patients with reduced ovarian reserve in order to identify a better regimen for these patients. This study was of a historical cohort type. Totally, 129 patient files were investigated including 48 versus 66 files related to fixed or flexible protocols, respectively. The mean of age, body mass index (BMI), follicle stimulating hormone (FSH), and anti-Mullerian hormone (AMH), as well as the mean dose of gonadotropin, the mean length of IVF/ICSI cycles, and the mean counts of oocytes and embryos with grading including good, fair, and poor were compared between the 2 groups. The total and mean consumption of gonadotropin dose (recombinant FSH) in the flexible and fixed groups were significantly different (P = 0.05). However, the mean antagonist (cetrotide) doses in the fixed and flexible groups were not significantly different while it was lower in the flexible group (P = 0.50). Finally, the duration of gonadotropin consumption in IVF/ICSI period was not significantly different between the two groups. In general, the fixed protocol is recommended in patients with reduced ovarian reserve since it is simple to use and more cost effective compared to the flexible protocol.