Background: Ovarian reserve is the determining factor in the composition and amount of the ovarian primordial follicular pool. The infertility of numerous couples is significantly influenced by poor ovarian reserve (POR), which is recognized by a decline in the amount of ovarian follicular pool age in females of fertile age. We aimed to compare between conventional gonadotropin releasing hormone antagonist and antagonist, stop - antagonist protocol (sandwich) protocol in poor responders undergoing ICSI.
Methods: This prospective randomized clinical study involved 50 poor responder females undergoing ICSI. Following evaluating 60 individuals, cases were equally and randomly assigned into: sandwich protocol and conventional GnRH antagonist protocol. The primary outcome was clinical pregnancy, and secondary involved oocyte yield, MII oocytes, fertilization rate, embryo quality, and β-hCG levels.
Results: The sandwich protocol demonstrated significantly superior outcomes compared with the conventional antagonist protocol, including higher numbers of retrieved and MII oocytes, improved fertilization rates, and a greater quantity of good-quality embryos (p < 0.001). Although β-hCG positivity was increased in the sandwich group, it wasn’t significant, while rate of clinical pregnancy was significantly greater (p = 0.037).
Conclusions: The sandwich protocol significantly improved ovarian response, fertilization rates, and embryo quality. Although β-hCG positivity was higher without statistical significance, clinical pregnancy rates were significantly increased, indicating improved outcomes in poor responders.