Fixed versus flexible gonadotropin releasing hormone antagonist protocol in women with polycystic ovary syndrome undergoing in vitro fertilization: An RCT

Fatehi H, Hanieh Fatehi, Robab Davar, Nikfarjam E, Elham Nikfarjam, Fatemeh Bayati, Bayati F
International journal of reproductive biomedicine · 2024 · vol. 22(8) , pp. 617–626 · doi:10.18502/ijrm.v22i8.17230 · PMID:39494117 · PMC11528296
RCT OA: gold CC-BY-NC-4.0
📄 Open PDF Full text JSON View on PubMed View at publisher
⚙ AI-generated summary by qwen3.7-flash, 2026-10-04 ⓘ

This randomized trial found that a flexible GnRH antagonist protocol yields significantly higher numbers of total and mature oocytes than a fixed protocol in women with polycystic ovary syndrome undergoing in vitro fertilization.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by qwen3.7-flash, 2026-09-24 · read from full text ⓘ

This randomized controlled trial compared fixed versus flexible GnRH antagonist protocols in 150 infertile women with polycystic ovary syndrome undergoing in vitro fertilization. The study found that the flexible protocol, which initiates antagonist administration based on follicle size, resulted in significantly higher numbers of metaphase II oocytes and total oocytes compared to the fixed day-5 initiation strategy. Additionally, patients in the flexible group required fewer doses of the GnRH antagonist, indicating a more tailored approach to ovarian stimulation. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

BACKGROUND: Despite the extensive use of the gonadotropin-releasing hormone (GnRH) antagonist protocol in treating infertile women, particularly those with polycystic ovary syndrome (PCOS), there have not been sufficient evidence to compare the flexible and fixed variants in in vitro fertilization (IVF) cycles. OBJECTIVE: This study aims to assess the treatment outcomes of flexible and fixed types of GnRH-antagonist protocol for IVF in women with PCOS. MATERIALS AND METHODS: In this randomized clinical trial, 150 infertile women with PCOS, who were candidates for IVF, and referred to the Yazd Research and Clinical Center for Infertility, Yazd, Iran between October 2023 and February 2024 were included. Participants were divided into 2 groups (n = 75/each) based on the type of antagonist protocol (fixed or flexible). GnRH antagonist administration started on the 5   th day of gonadotropin treatment in the fixed group. In the flexible group when there was at least one follicle 12-14 mm, GnRH antagonist was started. Finally, the number of metaphase II oocyte, the quality of embryos, the duration of the stimulation cycle, the dose of gonadotropin, the number of GnRH-antagonist, and the rate of ovarian hyperstimulation syndrome were evaluated. RESULTS: No statistically significant difference was observed in terms of cycle length and the total dose of gonadotropin between groups. Nevertheless, a notable distinction was observed in the total number of oocytes (17.84 vs. 15.5, p = 0.023) and mature oocytes (13.64 vs. 11.83, p = 0.019) in the flexible group compared to the fixed group. CONCLUSION: In conclusion, the IVF outcomes are more favorable in women with PCOS undergoing the flexible GnRH-antagonist protocol compared to the fixed protocol.
Full text 20,519 characters · extracted from pmc-nxml · 2 sections · click to expand

Section

H. Fatehi, R. Davar, and F. Bayati designed the study and conducted the research. H. Fatehi authored the paper and had access to all study data. E. Nikfarjam monitored and evaluated the result of the study. Further, R. Davar and E. Nikfarjam reviewed the article. All authors approved the final manuscript and are responsible for maintaining the integrity of the data and ensuring the accuracy of the presented information.

Coi Statement

The authors declare that there is no conflict of interest.

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: pmc-nxml ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Citation neighborhood (no data yet)

We don't have any in-corpus citations linked to this paper yet. This is a recent paper (2024) — citers typically take a year or two to land, and the OpenAlex reference graph may still be filling in.

Source provenance

europepmc
last seen: 2026-10-18T09:30:06.152893+00:00
pubmed
last seen: 2026-10-08T21:46:21.925728+00:00
unpaywall
last seen: 2026-05-21T05:10:58.409756+00:00
License: CC-BY-NC-4.0