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GnRH agonist trigger in focus: does protocol choice between PPOS and antagonist strategies affect outcomes?
Yusuf Aytaç Tohma1, Fazilet Kübra Boynukalın2, Meral Gültomruk3
1Department of Infertility, Bahceci Ankara IVF Center, Ankara, Turkey.
Archives of Gynecology and Obstetrics
|October 30, 2025
Summary
The Progestin-Only Suppression (PPOS) and Gonadotropin-Releasing Hormone (GnRH) antagonist protocols show similar oocyte yield and live birth rates when using a GnRH agonist trigger. Progestin use in PPOS does not negatively impact clinical outcomes in this context.
Area of Science:
- Reproductive Endocrinology
- In Vitro Fertilization (IVF)
Background:
- The choice of ovarian stimulation protocol impacts IVF outcomes.
- Gonadotropin-Releasing Hormone agonist (GnRHa) triggers are widely used.
- Comparing Progestin-Only Suppression (PPOS) and GnRH antagonist protocols is crucial for optimizing IVF treatment.
Purpose of the Study:
- To evaluate the effectiveness of GnRHa trigger in both PPOS and GnRH antagonist protocols.
- To compare oocyte yield and pregnancy rates between the two stimulation protocols.
Main Methods:
- Retrospective cohort study of 802 patients undergoing IVF.
- Patients received ovarian stimulation with gonadotropins followed by a GnRHa trigger.
- Comparison between GnRH antagonist (n=372) and PPOS (n=430) protocols.
Main Results:
- Both protocols yielded similar oocyte counts and embryological outcomes.
- Clinical pregnancy rates (63.6% vs. 63.8%) and live birth rates (51.7% vs. 52.2%) were comparable.
- Embryo quality, not stimulation protocol, predicted live birth.
Conclusions:
- PPOS and GnRH antagonist protocols result in similar oocyte yield and live birth rates with GnRHa trigger.
- Progestin use in PPOS is not linked to poorer clinical outcomes when using GnRHa trigger.
- Further research is needed to understand the mechanisms and long-term effects.
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