Can We Harvest More Mature Oocytes by Repeating Gonadotropin-Releasing Hormone Agonist Doses in Polycystic Ovarian Syndrome Patients at Risk of OHSS in Antagonist Cycles? A Randomised Clinical Trial

Background: There is an ongoing debate about the optimal dosage of gonadotropin-releasing hormone (GnRH)agonist for oocyte triggering in polycystic ovarian syndrome (PCOS) patients at risk for ovarian hyperstimulation syndrome(OHSS). In this study, we intend to ascertain whether the use of repeated doses of a GnRH agonist for oocytetriggering in these patients can enhance the outcomes of controlled ovarian stimulation (COS) for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Materials and Methods: This randomised clinical trial enrolled 70 PCOS women candidates for IVF/ICSI with thestandard antagonist protocol at Royan Institute (Tehran, Iran) from May 2020 to June 2022. Patients at risk of OHSSwith oestradiol (E2) levels 3000 pg/ml on the day of trigger were randomly assigned to a control or experimentalgroup. Group A (control group) patients received 0.2 mg triptorelin (Decapeptyl®) for final oocyte maturation. GroupB (experimental group) patients received a second dose of 0.1 mg Decapeptyl®12 hours after their first dose, for a totaldose of 0.3 mg. IVF/ICSI outcomes were compared between the groups. Results: Ultimately, 35 women from the study group and 33 from the control group completed the treatment cycle. Bothgroups were comparable in terms of demographic characteristics, baseline hormonal profiles, and PCOS phenotypes.The dosage of gonadotropin, stimulation duration, number of retrieved oocytes, oocyte maturation rate, and oocyte recoveryratio did not significantly differ between the groups. No significant differences were found in terms of the numberof blastocyst and cleavage embryos, nor the quality of obtained embryos between the groups. The mild to moderateOHSS rate was significantly lower in the study group (P=0.038). Conclusion: A second dose of GnRH agonist 12 hours after the first dose did not improve the number and maturity ofoocytes, or pregnancy outcomes in PCOS patients (registration number: NCT04600986).