Comparison of Luteal Phase Estradiol Priming Stimulation Protocol and the Standard Antagonist Protocol in Patients With Diminished Ovarian Reserve Undergoing ICSI

ObjectiveThis study aimed to compare the IVF outcomes in patients with diminished ovarian reserve stimulated with luteal phase estradiol (E2) priming protocol versus the standard antagonist protocol.MethodsThe study included 603 patients undergoing intracytoplasmic sperm injection cycles (ICSI) with the diagnosis of diminished ovarian reserve (DOR) who were stimulated with the luteal E2 priming protocol (n=181) and the standard antagonist protocol (n=422). Groups were compared in terms of demographic characteristics, ovarian stimulation results, ICSI cycle outcomes, clinical pregnancy, and live birth rates per embryo transfer. ResultsThe duration of ovarian stimulation was longer, and the total gonadotropin dose used was significantly higher (p=0.001) in the E2 priming protocol group than the antagonist protocol group. The number of embryos transferred was higher in the antagonist protocol group compared with the luteal E2 priming protocol group (0.87±0.75 vs. 0.64±0.49; p=001), but there was no statistically significant difference in terms of embryo quality (p>0.05). The cycle cancellation rate and the clinical pregnancy and live birth rates per embryo transfer were similar in both groups.ConclusionsThere was no significant difference between the ICSI outcomes of the patients diagnosed with diminished ovarian reserve stimulated with the antagonist protocol and the luteal E2 priming protocol. The antagonist protocol might be considered more advantageous because of the shorter treatment duration and lower doses of gonadotropin, and it allows more embryos to be transferred. Additional randomized controlled trials are needed to verify these findings.