Could the use of agonist protocols benefit patients who do not respond well to human reproduction treatment?

Objective: The primary goal of this article is to analyze whether there is still room for ovarian stimulation in poor responders prescribed the long protocol.

Methods: This retrospective cohort study analyzed the medical charts of patients seen at the Vida Centro de Fertilidade, a private fertility clinic in Rio de Janeiro, Brazil, from January 2018 to June 2023. It included poor responders described based on the Bologna criteria who were first prescribed conventional treatment with an antagonist protocol, without success, and then the long agonist protocol. Statistical analysis was performed on the Statistical Package for the Social Sciences (version 20). Comparisons of continuous variables between groups were performed with the Mann-Whitney U test or Student's t-test, as appropriate. The chi-square test was used to compare categorical variables. Statistical significance was achieved when p<0.05.

Results: We found a better response among patients on the agonist than on the antagonist protocol in terms of number of follicles larger than 14 mm on the day of trigger (3.17 versus 2.1; p<0.05), number of eggs on the day of retrieval (3.5 versus 1.37; p<0.05), number of mature eggs (2.67 versus 1.37; p<0.05), and number of embryos after fertilization on the first day of development (1.87 versus 0.8; p<0.05). This protocol's cancellation rate was slightly lower (0.03 versus 0.43; p<0.05).

Conclusions: The long protocol still yields positive results in poor responders who were previously prescribed the antagonist protocol.