An early and short gonadotropin releasing hormone (GnRH) antagonist (sandwich) protocol versus conventional gonadotropin releasing hormone (GnRH) antagonist in poor responders undergoing IVF/ICSI

In the field of IVF, the term ‘poor responder’ refers to the patients, with decreased ovarian reserve, that revealed as low retrieved oocytes in controlled ovarian hyperstimulation (COH) cycles which is a huge challenge in IVF. This study compares the effectiveness of an early and short gonadotropin releasing hormone (GnRH) antagonist (sandwich) protocol with conventional (GnRH) antagonist in poor ovarian responders. This randomized clinical trial consisted of 61 poor ovarian responder women enrolled in intra-cytoplasmic sperm injection (ICSI) cycles at High Institute for infertility Diagnosis and Assisted Reproductive Technologies, Baghdad, Iraq from January 2018 till February 2019. They were divided randomly in to two groups which are an early and short gonadotropin releasing hormone (GnRH) antagonist (sandwich) protocol group and conventional gonadotropin releasing hormone (GnRH) antagonist protocol group in order to compare between the two groups in the outcomes. The mean number of retrieved oocytes was significantly higher in sandwich than in conventional antagonist protocol (P = 0.026). Mean grade 1 embryo was significantly higher in sandwich protocol than in conventional protocol (P = 0.049). The rate of pregnancy was significantly higher in sandwich than that of conventional antagonist protocol (P = 0.026). Conclusion: An early GnRH antagonist (sandwich) protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle development