Impact of Prolonged Versus OCP Plus Long Protocol on IVF-ET Outcomes in Patients With Grade III-IV Endometriosis: A Randomized Clinical Trial

The purpose of the current study was to investigate the impact of a 2-months implementation of GnRH-agonist (prolonged) versus the OCP+long protocol before in-vitro fertilization-embryo transfer (IVF-ET) on IVF outcomes in infertile patients with Grade III-IV endometriosis. A total of 70 infertile patients with endometriosis participated in this randomized clinical trial and randomly received either the prolonged GnRH-agonist protocol (38 patients) as control or the OCP+long protocol (32 patients) as the case group. This was followed by standard controlled ovarian hyperstimulation (COH) in all subjects. The fertilization rate, the implantation rate, and the clinical pregnancy rate were measured and compared between the two groups. A statistically significant trend toward better embryo quality was observed in the control group (P=0.01). In addition, clinical pregnancy rate, implantation rate and fertilization rate did not differ significantly between two groups (P=0.43, P=0.54, P=0.1 respectively). GnRH agonist treatment for 2 months before ART in women with high-grade endometriosis was associated with better embryo quality compared to three weeks of treatment with OCP. OCP before assisted reproductive technology (ART) was as effective as GnRH agonist treatment regarding clinical pregnancy and implantation rates in infertile patients with severe endometriosis.