Comparison of the efficacy of progestin-primed ovarian stimulation (PPOS) and GnRH antagonist protocols in patients undergoing controlled ovarian stimulation for in vitro fertilization (ivf)

AIM: The aim of this study was to compare the frequency of premature ovulation, the number of oocytes retrieved, the number of high-quality embryos developed, and the cumulative pregnancy outcomes following fresh or frozen embryo transfers (ET) in patients undergoing controlled ovarian stimulation (COS) using either GnRH antagonists or progestin primed ovarian stimulation (PPOS) to prevent early LH surges. MATERIALS AND METHODS: Between January 2022 and March 2024, 200 patients aged between 18 and 43 years, who met the exclusion criteria and underwent controlled ovarian stimulation for IVF at the Assisted Reproductive Technologies Center of Sakarya University Faculty of Medicine, were included in the study. Among these patients, the total number of oocytes retrieved, the number of MII oocytes, 2PN fertilization rates, total embryo quality, beta HCG positivity, live birth outcomes, OHSS rates, and the doses and duration of gonadotropins used were evaluated. RESULTS: There was no statistically significant difference between the patient groups in terms of age, body mass index, embryo transfer age, number of embryos transferred, endometrial thickness, duration of infertility, and levels of FSH, AMH, PRL, TSH, and T4 (P˃0.05). Although there was a difference in the number of oocytes retrieved between the PPOS and GnRH antagonist protocols, the rates of high-quality embryos and clinical live births were similar between the two groups. CONCLUSION: This study highlights that while the GnRH antagonist protocol requires daily injections and is associated with higher costs, the PPOS protocol, recognized as a new treatment approach, offers ease of use and lower costs. Despite concerns that the PPOS protocol may negatively impact oocyte quality and reduce embryo quality and pregnancy rates, no significant differences were observed between the two protocols in these outcomes. Keywords: GnRH antagonists, oosit pick up, progestin