IVF treatment protocol and quality of life

There are 3 main IVF protocols we use regularly: antagonist, agonist, MD Agonist Flare. Sure, there are plenty of variations on these protocols, but essentially all protocols come from these 3, even minimal stimulation IVF, natural cycle IVF and others. Study after study has shown that there is little difference between pregnancy outcomes with the different protocols. What does seem to matter is what dose your physician picks for you, the timing of the different medications used during the protocol and the "extra" medications that are used based on the patients diagnosis and ovarian reserve (e.g. growth hormone, steriods, etc). So, it's not cookie cutter, by any means, but the bones of the protocols are similar and they have similar pregnancy outcomes.

So, why do we pick one protocol over another? At Olive we like antagonist protocols as they are flexible, safer in that there is less OHSS, they do not over-suppress the ovaries prior to stimulation and the medications costs a little less than other protocols. A paper published this month in Fertility & Sterility suggests that women who are treated with an antagonist protocol do better mentally. The study compared women who underwent an antagonist protocol to those who underwent an agonist protocol. They studies 1023 women. They found that "women in the GnRH antagonist group felt less emotional (adjusted odds ratio [AOR] 0.69), less limited in their everyday life (AOR 0.74), experienced less unexpected crying (AOR 0.71), and rated quality of sleep better (AOR 1.55). Further, women receiving GnRH agonist treatment felt worse physically."

Reference: Toftager M, et al . Quality of life and psychosocial and physical well-being among 1,023 women during their first assisted reproductive technology treatment: secondary outcome to a randomized controlled trial comparing gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist protocols. Fertil Steril. 2018 Jan;109(1):154-164.

There are certainly patients I prefer an agonist protocol for, but about 70% of the time antagonist protocols give us the best stimulation possible with excellent pregnancy rates. It's not polite to brag, but we have among the highest in Canada and the highest in several categories.....

So, if we can stimulate the ovaries in IVF and minimize the mental and physical toll of the treatment, why not?