The Effectiveness and Disadvantages of Some Protocols Used for Ovulation Induction and in Vitro Infertility Treatment

Recent decades have witnessed significant development advances in In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI), core Assisted Reproductive Technologies (ART). These techniques are considered a revolution in infertility treatment for couples facing challenges. They depend on inducing ovulation (Controlled Ovarian Stimulation (COS)) Using multiple hormonal protocols to boost mature eggs for better fertilization. IVF being the most common ART for conception, it is used in managing cases of patients who have difficulty achieving pregnancy. GnRH (Gonadotropin-Releasing Hormone) protocols are widely used in IVF for ovulation induction, divided into: Agonist protocol (gradual LH suppression, longer) and Antagonist protocol (immediate LH suppression, faster). Recent studies have showed differences in rates of live birth, OHSS (Ovarian Hyperstimulation Syndrome) risk, and maternal/fetal safety when comparing these two protocols. Systematic reviews and meta-analyses show that the GnRH-antagonist protocol has equivalent effectiveness in clinical pregnancy and live birth rates comparing to the GnRH-agonist protocol, but with better safety, lower (OHSS) risk. Based on global studies, there was controversy about the effectiveness of the second (antagonistic) protocol, which prompted us to conduct this study to compare the effectiveness and safety of these two protocols. This study was conducted to compare protocols used for ovulation induction among patients attending fertility clinics in Syria. The study included two groups of patients: the first group ( 350 participants) used Triptorelin as a GnRH agonist (agonist group), and the second group (110 participants) used Cetrorelix as a GnRH antagonist (antagonist group).The results of this study showed that the protocol based on the use of the GnRH agonist is the most used in Syria. When comparing between these two protocols, we found that the rate of ovarian hyperstimulation was similar between the two groups and negligible, as both drugs achieved a hyperstimulation rate of 0%. On the other hand, the antagonist group achieved a higher fertilization rate than the agonist group by 10-15%. Also, the quality of the eggs was better in the antagonist group, but the rates of collecting fertilizable eggs were lower than the agonist group.