Clinical outcome of Stimulation Protocols in Assisted Reproductive Technology

Abstract

Background: Assisted Reproductive Technology (ART) is a complex and costly procedure where individualized ovarian stimulation protocols play a pivotal role in determining outcomes. Appropriate selection of stimulation protocols based on patient characteristics can improve treatment success. Evaluating these protocols through standard key performance indicators (KPIs) provides insight into clinical efficacy and patient benefit. Objective: To compare and evaluate the clinical outcome of stimulation protocols of ART. Methods: This Quasi-experimental study was conducted in the Department of Reproductive Endocrinology and Infertility at CMH Dhaka from September 2022 to August 2023. A total of 70 patients undergoing IVF were included, with 32 (45.7%) managed using gonadotropin releasing hormone (GnRH) agonist protocol and 38 (54.3%) with GnRH antagonist protocol. Clinical outcomes assessed included cycle cancellation rate prior to oocyte pick-up (OPU), ovarian hyperstimulation syndrome (OHSS) incidence, empty follicle syndrome (EFS), oocyte retrieval rate, proportion of metaphase II (MII) oocytes at ICS and OPU-related complications. Results: Cycle cancellation rates were 3.1% for the agonist group and 7.9% for the antagonist group. Oocyte retrieval rates exceeded 60% among about half of the patients in both protocols. EFS was observed in 5.3% of antagonist cases but none in the agonist group. A significantly higher proportion of MII oocytes (>70%) was seen in the antagonist protocol (p<0.05). OHSS occurred in 7.9% of antagonist and 3.1% of agonist cycles. OPU complications occurred in 2.6% of antagonist cases and none in the agonist group. Conclusion: Both agonist and antagonist protocols demonstrated comparable clinical outcomes. The findings suggest that either protocol can be effectively used in ART, with selection tailored to individual patient profiles.

Bangladesh Armed Forces Med J Vol 58 No (1) June 2025, pp 61-67