Antagonist administration from day 1 of IVF versus standard flexible day 5/6 antagonist administration in PCOS patients

GnRHAntagonist protocols are now accepted as the preferred choice for IVF in PCOS patients as, compared to GnRH agonist protocols, they have been shown to offer the distinct advantage of lower incidence of OHSS, while simultaneously offering comparable pregnancy rates. This is of further benefit as antagonist protocol may be combined with agonist trigger and delayed frozen embryo transfer, further lowering risk of OHSS. Standard antagonist protocol involves antagonist administration from day 5 or day 6 to prevent premature luteinization. However, studies have shown that deranged endocrinologic profile in PCOS patients- specifically, elevated serum LH levels at the start of the cycle- may negatively impact IVF outcome due to impaired follicular development and egg quality. We recently published our retrospective data showing significantly improved outcomes in PCOS patients when antagonist is administered from day 1 of stimulation, compared to flexible antagonist administration from day 5 or day 6.