Effect of Prolonged Ovarian Stimulation (24 and 48 Hours) Compared to Conventional Duration on IVF/ICSI Outcomes: A Single-Blind Randomized Clinical Trial

Background: Infertility is a global public health concern, and controlled ovarian stimulation (COS) plays a crucial role in assisted reproductive technologies (ART) by facilitating the retrieval of multiple oocytes. This single-blind randomized clinical trial aimed to evaluate whether extending the duration of COS by 24 and 48 hours beyond the conventional protocol would affect pregnancy rates in couples undergoing IVF/ICSI. Materials and Methods: Ninety patients were randomized into three groups: control (GC), 24-hours longer (G24), and 48-hours longer (G48), using block randomization. The GC group followed the standard COS protocol, while G24 and G48 received extended COS for their respective durations. Primary outcomes included imaging-proven pregnancy at six weeks gestation, chemical pregnancy, and clinical pregnancy post-embryo transfer. Secondary outcomes included follicle, oocyte, and embryo counts. Results: Baseline characteristics were comparable across groups. Antral follicle count (AFC) and anti-Müllerian hormone (AMH) levels were positively correlated with pregnancy outcomes. Significant associations were observed between AFC/AMH and follicle/oocyte/embryo counts. Although embryo counts varied among groups, no significant differences in primary or secondary outcomes were found. A trend towards improved outcomes was noted from GC to G48, but without statistical significance. Conclusion: The study did not find significant differences in pregnancy rates or other outcomes with prolonged COS durations compared to conventional protocols. However, the results suggest a need for further research to explore the effects of extended COS in specific patient subsets, as existing literature indicates potential benefits.