en مقایسه پروتکل ثابت و متغیر آنتاگونیست هورمون آزادکننده گنادوتروپین در زنان نابارور مبتلا به سندرم تخمدان پلی‌کیستیک تحت لقاح آزمایشگاهی: یک کارآزمایی بالینی Fertility & Infertility Original Article Original Article <div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">علیرغم استفاده گسترده از پروتکل هورمون آزادکننده گنادوتروپین </span></span><span dir="LTR" style="font-size:10.0pt">(GnRH)</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">آنتاگونیست در درمان زنان نابارور، بخصوص موارد مبتلا به سندرم تخمدان پلی</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">کیستیک (</span></span><span dir="LTR" style="font-size:10.0pt">PCOS</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) در سیکل لقاح خارج رحمی (</span></span><span dir="LTR" style="font-size:10.0pt">IVF</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">)، مطالعات کافی در زمینه مقایسه نوع متغیر و ثابت این پروتکل تا بحال صورت نگرفته است.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">این مطالعه با هدف مقایسه و بررسی اثر نتایج درمان با نوع متغیر </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> آنتاگونیست نسبت به نوع ثابت در زنان مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt">PCOS</span><span style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> در </span></span><span dir="LTR" style="font-size:10.0pt">IVF</span><span style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> انجام شد.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مواد و روش&shy; ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در این کارآزمایی بالینی تصادفی شده، 150 زن نابارور مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt">PCOS</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> مراجعه</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">کننده به پژوهشکده علوم تولید مثل یزد و کاندیدای </span></span><span dir="LTR" style="font-size:10.0pt">IVF</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> وارد مطالعه شدند. این زنان در بازه زمانی اکتبر 2023 تا فوریه 2024 به این مرکز مراجعه کردند. شرکت</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">کنندگان بر اساس نوع پروتگل آنتاگونیست (ثابت یا متغیر) به دو گروه 75 نفره تقسیم شدند (75 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">n</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">). تجویز آنتاگونیست در گروه ثابت از روز پنجم درمان گنادوتروپین و در گروه متغیر نیز زمانی که حداقل یک فولیکول </span></span><span dir="LTR" style="font-size:10.0pt">mm</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> 12-14 وجود داشت شروع شد. در نهایت پیامدهایی شامل تعداد تخمک‌های بالغ (متافاز دوم)، کیفیت جنین‌ها، طول چرخه تحریک، دوز گنادوتروپین، تعداد آنتاگونیست </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> و شدت سندرم هیپراستیمولاسیون تخمدانی مورد ارزیابی قرار گرفت.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">بر اساس نتایج، طول چرخه و مجموع دوز گنادوتروپین در دو گروه مورد بررسی از نظر آماری دارای تفاوت معنی‌دار نبود با این حال، تفاوت قابل توجه و معنی&shy;داری بین تعداد کل تخمک&shy;ها (84/17 در برابر 5/15 و 023/0 </span></span><span dir="LTR" style="font-size:10.0pt">p</span> <span dir="LTR" style="font-size:10.0pt">=</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) و تعداد تخمک&shy;های بالغ (64/13 در برابر 83/11 و 019/0 </span></span><span dir="LTR" style="font-size:10.0pt">p</span> <span dir="LTR" style="font-size:10.0pt">=</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) در گروه متغیر نسبت به گروه ثابت وجود داشت.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتیجه &shy;گیری: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">به نظر می&shy;رسد پیامدهای سیکل </span></span><span dir="LTR" style="font-size:10.0pt">IVF</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> در پروتکل متغیر </span></span><span dir="LTR" style="font-size:10.0pt">GnRH</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> آنتاگونیست در مقایسه با پروتکل ثابت، در زنان نابارور مبتلا به </span></span><span dir="LTR" style="font-size:10.0pt">PCOS</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> بهتر می</span></span><span dir="LTR" style="font-size:11.0pt"><span arial="" style="font-family:">&shy;</span></span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">باشد.</span></span><b><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial","sans-serif""></span></span></b></span></span></span></span></span></div> <div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:normal"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Background: </span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Despite the extensive use of the gonadotropin-releasing hormone (GnRH) antagonist protocol in treating infertile women, particularly those with polycystic ovary syndrome (PCOS), there have not been sufficient evidence to compare the flexible and fixed variants in in vitro fertilization (IVF) cycles.</span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Objective: </span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">This study aims to assess the treatment outcomes of flexible and fixed types of GnRH-antagonist protocol for IVF in women with PCOS. </span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Materials and Methods: </span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">In this randomized clinical trial, 150 infertile women with PCOS, who were candidates for IVF, and referred to the Yazd Research and Clinical Center for Infertility, Yazd, Iran between October 2023 and February 2024 were included. Participants were divided into 2 groups (n = 75/each) based on the type of antagonist protocol (fixed or flexible). GnRH antagonist administration started on the 5^th day of gonadotropin treatment in the fixed group. In the flexible group when there was at least one follicle 12-14 mm, GnRH antagonist was started. Finally, the number of metaphase II oocyte, the quality of embryos, the duration of the stimulation cycle, the dose of gonadotropin, the number of GnRH-antagonist, and the rate of ovarian hyperstimulation syndrome were evaluated.</span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Results:</span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times=""> No statistically significant difference was observed in terms of cycle length and the total dose of gonadotropin between groups. Nevertheless, a notable distinction was observed in the total number of oocytes (17.84 vs. 15.5, p = 0.023) and mature oocytes (13.64 vs. 11.83, p = 0.019) </span></span><span lang="EN-GB" style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">in the flexible group compared to the fixed group.</span></span> <span style="font-size:12.0pt"><span style="font-family:"Times New Roman","serif""></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><span sans-serif="" style="font-family:Calibri,"><b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">Conclusion: </span></span></b><span style="font-size:12.0pt"><span new="" roman="" style="font-family:" times="">In conclusion, the IVF outcomes are more favorable in women with PCOS undergoing the flexible GnRH-antagonist protocol compared to the fixed protocol.</span></span></span></span></span></div> هورمون آزادکننده گنادوتروپین, سندروم تخمدان پلی‌کیستیک, لقاح آزمایشگاهی, تخمک. Gonadotropin-releasing hormone, Polycystic ovary syndrome, Fertilization in vitro, Oocytes. 617 626 http://ijrm.ir/browse.php?a_code=A-10-2759-1&slc_lang=en&sid=1 Hanieh Fatehi Dr.Fatehi435@Gmail.Com 0009-0002-0954-7101 No Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Robab Davar r_davar@yahoo.com 0000-0002-5296-5707 Yes Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Elham Nikfarjam Elhamnikfarjam2022@Yahoo.Com 0009-0009-0612-7858 No Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Fatemeh Bayati drfb2941@gmail.com 0000-0003-4527-1878 No Department of Obstetrics and Gynecology, Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.