Comparative evaluation of High- vs. Low-Ovarian stimulation doses in PCOS patients: impact on ICSI outcomes

Abstract Background Currently, the optimal method of ovarian stimulation (OS) for in-vitro fertilization (IVF) in the patients with polycystic ovarian syndrome (PCOS) is unknown. The present research aims to study the efficacy of High-OS method for treating infertile patients with PCOS and to compare it with a low-OS protocol. Methods The study was an open label, randomized, parallel treatment clinical trial comparing a high stimulatory gonadotropin dose (group A) to low stimulatory dose (group B) in PCOS infertile women undergoing ICSI cycle for infertility management in El Madina fertility Center between December 2023 and March 2025. IVF outcomes of two groups were analyzed statistically. Results The statistical analysis showed that group A of high stimulation dose had a shorter stimulation duration ( P = 0.025) and numerically higher numbers of retrieved oocytes, MII oocytes, embryos formed, and numerically higher clinical pregnancy rates without reaching statistical significance than group B of low stimulation dose. High-OS protocol showed numerically higher fertilization and clinical pregnancy rates without an increased risk of OHSS. Conclusions High-OS with r-FSH may be a beneficial method of controlled ovarian stimulation (COS) in non-obese infertile women with PCOS in respect to total dose of prescribed gonadotropin, the optimal number of retrieved oocytes and embryos obtained, fertilization rate and clinical pregnancy rate without increased risk of OHSS.