Effect of Estradiol Pretreatment on Follicular Synchronization and IVF Outcomes in Women With Polycystic Ovary Syndrome Undergoing ICSI Using GnRH Antagonist Protocol

Controlled ovarian stimulation was initiated on day 2 of the menstrual cycle using individualized gonadotropin doses according to age, BMI, AMH, and AFC. GnRH antagonist was initiated once at least one follicle reached 13 mm diameter.

Ovulation trigger was administered when at least five follicles reached ≥17 mm. Add reference Oocyte retrieval was performed 36 hours after trigger under transvaginal ultrasound guidance.

Women in the pretreatment group received oral estradiol valerate (Cycloprogynova) 4 mg/day during the luteal phase from day 21 of prior cycle To day 2 of COH ovarian stimulation cycle while women in the control group underwent standard GnRH antagonist stimulation without estradiol pretreatment.

Inclusion criteria

• PCOS was defined by the presence of at least two of the following:

• oligo or anovulation,
• clinical or biochemical hyperandrogenism, and
• polycystic ovarian morphology on ultrasound (≥12 antral follicles 2-9 mm in diameter and/or ovarian volume >10 mL).

All participants had undergone failed ovulation induction or were candidates for IVF/ICSI due to male factor infertility.

Exclusion criteria

• previous ovarian surgery
• endometriosis
• known chromosomal abnormalities
• untreated thyroid disease
• body mass index (BMI) > 35 kg/m²
• basal FSH >12 IU/L
• use of hormonal medications within 3 months prior to the study.