Invitro Fertilization Clinical Trial
Official title:
Long Protocol and Freeze All Embryos vs Antagonist Protocol With Fresh Embryo Transfer in PCOS Patients Undergoing ICSI
Patients will be divided into two groups Group A; patients using long protocol and freeze all
embryos Group B; patients using antagonist protocol with fresh embryo transfer Patients will
be carefully chosen according to a strict inclusion and exclusion criteria after meticulous
revision of patient files.
In the long protocol, daily SC injection of Triptorelin :Decapeptyl 0.1 mg (Ferring,
Switzerland) 0.1 mg started at day 21 of the cycle prior to stimulation cycle and continued
till the day of hCG triggering. Gn stimulation started after fulfilling stimulation start
criteria of thin endometrium < 5 mm and low E2 < 50 and LH < 5IU/l with either HMG(Menogon;
Ferring, Switzerland) or rFSH (Gonal-f; Merck Serono, Germany) in a starting dose of 150-300
IU/day according to women age, day 3 FSH,AMH and previous gonadotropin response then
adjustment of the dose according to ovarian response monitored by serum E2 and ultrasound
evaluation. All patients were followed up by Transvaginal ultrasound scan daily or on
alternate days according to the ovarian response to treatment starting on treatment cycle day
(6) for folliculometry and endometrial thickness and pattern.
Triggering by HCG 10000 IU IM (Pregnyl, Organon, the Netherlands) when 2 or more follicles
have 18 mm as a mean diameter .
Flexible GnRH antagonist protocol was done with daily s.c administration of cetrorelix 0.25
mg (Cetrotide, Merck Serono, Darmstadt, Germany) started when one or more of the following
criteria were achieved: (i) one or more follicle reached 14 mm diameter; (ii) The level of
serum E2 reached 600 pg/ml; and (iii) The level of serum LH levels reached 10 IU/l . Daily sc
rFSH (Gonal-f; Merck Serono , Darmstadt, Germany) injections was started on 2nd day of the
cycle in the antagonist protocol. Continuation of rFSH and GnRH antagonist daily until
triggering day was done.
Patients will be divided into two groups Group A; patients using long protocol and freeze all
embryos Group B; patients using antagonist protocol with fresh embryo transfer Patients will
be carefully chosen according to a strict inclusion and exclusion criteria after meticulous
revision of patient files.
In the long protocol, daily SC injection of Triptorelin :Decapeptyl 0.1 mg (Ferring,
Switzerland) 0.1 mg started at day 21 of the cycle prior to stimulation cycle and continued
till the day of hCG triggering. Gn stimulation started after fulfilling stimulation start
criteria of thin endometrium < 5 mm and low E2 < 50 and LH < 5IU/l with either HMG(Menogon;
Ferring, Switzerland) or rFSH (Gonal-f; Merck Serono, Germany) in a starting dose of 150-300
IU/day according to women age, day 3 FSH,AMH and previous gonadotropin response then
adjustment of the dose according to ovarian response monitored by serum E2 and ultrasound
evaluation. All patients were followed up by Transvaginal ultrasound scan daily or on
alternate days according to the ovarian response to treatment starting on treatment cycle day
(6) for folliculometry and endometrial thickness and pattern.
Triggering by HCG 10000 IU IM (Pregnyl, Organon, the Netherlands) when 2 or more follicles
have 18 mm as a mean diameter .
Flexible GnRH antagonist protocol was done with daily s.c administration of cetrorelix 0.25
mg (Cetrotide, Merck Serono, Darmstadt, Germany) started when one or more of the following
criteria were achieved: (i) one or more follicle reached 14 mm diameter; (ii) The level of
serum E2 reached 600 pg/ml; and (iii) The level of serum LH levels reached 10 IU/l . Daily sc
rFSH (Gonal-f; Merck Serono , Darmstadt, Germany) injections was started on 2nd day of the
cycle in the antagonist protocol. Continuation of rFSH and GnRH antagonist daily until
triggering day was done.
Cycle cancellation was decided when transvaginal ultrasound scan on cycle day (9) revealed no
adequate follicular growth (<3 mature follicles),if no oocytes were retrieved on ovum pick
up,or if failure of fertilization occurred. If signs of early OHSS were observed at 3rd day
of ovum pickup ,cancellation of ET was done with elective embryo cryopreservation as it may
end with life-threatening OHSS . ET was cancelled also if any criteria of hospital admission
was found
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