Amaç: Bu çalışma, oral kontraseptif ön tedavisini takiben GnRH antagonist protokolünün erken başlatılmasının, konvansiyonel başlatma ile karşılaştırıldığında, PCOS hastalarında IVF etkinliğini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Toplam 24 PCOS hastası rastgele iki gruba ayrıldı: erken antagonist grubu (GnRH antagonisti stimülasyonun ilk gününde başlatıldı) ve konvansiyonel grup (antagonist, önde gelen folikül 13-14 mm boyutuna ulaştığında başlatıldı). Değerlendirilen temel sonuçlar arasında toplanan oosit sayısı, fertilizasyon oranları, implantasyon oranları ve klinik gebelik oranları yer aldı. Bulgular: Erken antagonist grubundaki hastalar, anlamlı derecede daha yüksek dozda GnRH antagonisti gereksinimi gösterdi (p <0.05) ve konvansiyonel gruba kıyasla hafifçe daha ince endometrium kalınlığına sahipti (p=0.043). Ancak, iki grup arasında toplanan oosit sayısı (p=0.140), fertilizasyon oranları (p=0.311), implantasyon oranları (p=0.210) veya klinik gebelik oranları (p=0.682) açısından anlamlı fark saptanmadı. Her iki protokol de güvenli bulundu ve hiçbir hastada OHSS vakası bildirilmedi. Sonuç: Oral kontraseptif ön tedavisini takiben GnRH antagonistinin erken başlatılması, PCOS hastalarında IVF sonuçlarını konvansiyonel başlatmaya kıyasla anlamlı şekilde iyileştirmemektedir. Erken başlatma, siklus programlamasında belirli avantajlar sağlayabilse de, daha yüksek dozda antagonist kullanımını gerektirmekte ve endometrial reseptiviteyi potansiyel olarak etkileyebilmektedir. Belirli hasta alt gruplarının bireyselleştirilmiş protokollerden fayda sağlayıp sağlayamayacağını belirlemek için daha ileri araştırmalara ihtiyaç vardır.

Objective: This study aimed to evaluate the effectiveness of early initiation of the GnRH antagonist protocol following oral contraceptive pretreatment compared to the conventional initiation in PCOS patients undergoing IVF. Material and Methods: A total of 24 PCOS patients were randomized into two groups: the early antagonist group, where GnRH antagonist was initiated on the first day of stimulation, and the conventional group, where the antagonist was introduced when the lead follicle reached a size of 13-14 mm. Key outcomes assessed included the number of oocytes retrieved, fertilization rates, implantation rates, and clinical pregnancy rates. Results: Patients in the early antagonist group required significantly higher doses of the GnRH antagonist (p <0.05) and had a slightly thinner endometrial thickness compared to the conventional group (p=0.043). However, no significant differences were found between the groups regarding the number of oocytes retrieved (p=0.140), fertilization rates (p=0.311), implantation rates (p=0.210), or clinical pregnancy rates (p=0.682). Both protocols were found to be safe, with no cases of OHSS reported in either group. Conclusion: Early initiation of the GnRH antagonist following oral contraceptive pretreatment does not significantly improve IVF outcomes in PCOS patients compared to conventional initiation. While early initiation may have specific benefits in cycle scheduling, it requires higher doses of antagonists and could potentially affect endometrial receptivity. Further research is warranted to identify patient subgroups that might benefit from tailored protocols.

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