{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:21:50Z","timestamp":1786980110620,"version":"build-2736575974"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Gynecol Obstet"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this study was to assess the effectiveness of the GnRHa trigger in the PPOS and GnRH antagonist protocols when using a GnRH agonist (GnRHa) trigger.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study conducted at Bah\u00e7eci Fulya IVF Center (January 2022\u2013January 2024) included 802 patients undergoing ovarian stimulation with a starting dose of 300 IU gonadotropins using either a GnRH antagonist (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009372) or PPOS protocol (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009430), followed by a GnRHa trigger. The primary outcome was oocyte yield; secondary outcomes included pregnancy rates following the initial frozen embryo transfer (FET).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics, including female age, BMI, and infertility duration, were comparable between groups. Although PPOS was associated with a shorter stimulation duration [10 (9\u201311) vs. 10 (10\u201311) days,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002], lower progesterone levels on trigger day [1.3 (0.74\u20131.48) vs. 1.5 (0.83\u20131.63) ng\/ml,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002], and higher LH levels [4 (1.89\u20135.2) vs. 3.3 (1.4\u20134.1) IU,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001], oocyte yield and embryological outcomes were similar (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05 for all). Clinical pregnancy rates [63.6% vs. 63.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.95] and live birth rates [51.7% vs. 52.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.87] were also comparable. Regression analysis identified embryo quality (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), but not stimulation protocol (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.766), as a significant predictor of live birth.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PPOS and GnRH antagonist protocols provide similar oocyte yield and live birth rates following GnRHa trigger. These findings indicate that progestin use in PPOS is not associated with inferior clinical outcomes in the setting of GnRHa trigger; however, the underlying mechanisms and long-term efficacy require further investigations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-025-08229-7","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T19:38:59Z","timestamp":1761766739000},"page":"2303-2309","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["GnRH agonist trigger in focus: does protocol choice between PPOS and antagonist strategies affect outcomes?"],"prefix":"10.1007","volume":"312","author":[{"given":"Yusuf Ayta\u00e7","family":"Tohma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazilet K\u00fcbra","family":"Boynukal\u0131n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meral","family":"G\u00fcltomruk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Bah\u00e7eci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcrkan","family":"Bozda\u011f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"issue":"3","key":"8229_CR1","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1093\/humupd\/dmac040","volume":"29","author":"CA Venetis","year":"2023","unstructured":"Venetis CA, Storr A, Chua SJ, Mol BW, Longobardi S, Yin X et al (2023) What is the optimal GnRH antagonist protocol for ovarian stimulation during ART treatment? A systematic review and network meta-analysis. Hum Reprod Update 29(3):307\u2013326. https:\/\/doi.org\/10.1093\/humupd\/dmac040","journal-title":"Hum Reprod Update"},{"issue":"2\u20133","key":"8229_CR2","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/s0378-4320(97)00075-4","volume":"49","author":"DJ Patterson-Bay","year":"1997","unstructured":"Patterson-Bay DJ, Geisert RD, Hill CM, Minton JE, McCann JP, Morgan GL (1997) GnRH antagonist inhibition of luteinizing hormone secretion and ovulation in the pig. Anim Reprod Sci 49(2\u20133):207\u2013214. https:\/\/doi.org\/10.1016\/s0378-4320(97)00075-4","journal-title":"Anim Reprod Sci"},{"issue":"4","key":"8229_CR3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0175985","volume":"12","author":"R Wang","year":"2017","unstructured":"Wang R, Lin S, Wang Y, Qian W, Zhou L (2017) Comparisons of GnRH antagonist protocol versus GnRH agonist long protocol in patients with normal ovarian reserve: a systematic review and meta-analysis. PLoS ONE 12(4):e0175985. https:\/\/doi.org\/10.1371\/journal.pone.0175985","journal-title":"PLoS ONE"},{"key":"8229_CR4","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.1004352","volume":"13","author":"Q Chen","year":"2022","unstructured":"Chen Q (2022) Editorial: Recent advances in progestin-primed ovarian stimulation. Front Endocrinol (Lausanne) 13:1004352. https:\/\/doi.org\/10.3389\/fendo.2022.1004352","journal-title":"Front Endocrinol (Lausanne)"},{"key":"8229_CR5","first-page":"57","volume":"59","author":"NP Evans","year":"2002","unstructured":"Evans NP, Richter TA, Skinner DC, Robinson JE (2002) Neuroendocrine mechanisms underlying the effects of progesterone on the oestradiol-induced GnRH\/LH surge. Reprod Suppl 59:57\u201366","journal-title":"Reprod Suppl"},{"issue":"10\u201311","key":"8229_CR6","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1016\/s0039-128x(00)00187-2","volume":"65","author":"N Chabbert-Buffeta","year":"2000","unstructured":"Chabbert-Buffeta N, Skinner DC, Caraty A, Bouchard P (2000) Neuroendocrine effects of progesterone. Steroids 65(10\u201311):613\u2013620. https:\/\/doi.org\/10.1016\/s0039-128x(00)00187-2","journal-title":"Steroids"},{"issue":"9","key":"8229_CR7","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1093\/humrep\/15.9.1965","volume":"15","author":"J Itskovitz-Eldor","year":"2000","unstructured":"Itskovitz-Eldor J, Kol S, Mannaerts B (2000) Use of a single bolus of GnRH agonist triptorelin to trigger ovulation after GnRH antagonist ganirelix treatment in women undergoing ovarian stimulation for assisted reproduction, with special reference to the prevention of ovarian hyperstimulation syndrome: preliminary report: short communication. Hum Reprod 15(9):1965\u20131968. https:\/\/doi.org\/10.1093\/humrep\/15.9.1965","journal-title":"Hum Reprod"},{"issue":"1","key":"8229_CR8","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.fertnstert.2007.02.002","volume":"89","author":"L Engmann","year":"2008","unstructured":"Engmann L, DiLuigi A, Schmidt D, Nulsen J, Maier D, Benadiva C (2008) The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril 89(1):84\u201391. https:\/\/doi.org\/10.1016\/j.fertnstert.2007.02.002","journal-title":"Fertil Steril"},{"issue":"5","key":"8229_CR9","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1093\/humrep\/deh765","volume":"20","author":"P Humaidan","year":"2005","unstructured":"Humaidan P, Bredkjaer HE, Bungum L, Bungum M, Grondahl ML, Westergaard L et al (2005) GnRH agonist (buserelin) or hCG for ovulation induction in GnRH antagonist IVF\/ICSI cycles: a prospective randomized study. Hum Reprod 20(5):1213\u20131220. https:\/\/doi.org\/10.1093\/humrep\/deh765","journal-title":"Hum Reprod"},{"issue":"10","key":"8229_CR10","doi-asserted-by":"publisher","first-page":"2887","DOI":"10.1093\/humrep\/dei150","volume":"20","author":"EM Kolibianakis","year":"2005","unstructured":"Kolibianakis EM, Schultze-Mosgau A, Schroer A, van Steirteghem A, Devroey P, Diedrich K et al (2005) A lower ongoing pregnancy rate can be expected when GnRH agonist is used for triggering final oocyte maturation instead of HCG in patients undergoing IVF with GnRH antagonists. Hum Reprod 20(10):2887\u20132892. https:\/\/doi.org\/10.1093\/humrep\/dei150","journal-title":"Hum Reprod"},{"issue":"3","key":"8229_CR11","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1097\/GCO.0000000000000701","volume":"33","author":"P Humaidan","year":"2021","unstructured":"Humaidan P, Kol S (2021) Suboptimal response to GnRH agonist trigger: causes and practical management. Curr Opin Obstet Gynecol 33(3):213\u2013217. https:\/\/doi.org\/10.1097\/GCO.0000000000000701","journal-title":"Curr Opin Obstet Gynecol"},{"issue":"1","key":"8229_CR12","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12958-019-0549-9","volume":"17","author":"FK Boynukalin","year":"2019","unstructured":"Boynukalin FK, Gultomruk M, Turgut E, Demir B, Findikli N, Serdarogullari M et al (2019) Measuring the serum progesterone level on the day of transfer can be an additional tool to maximize ongoing pregnancies in single euploid frozen blastocyst transfers. Reprod Biol Endocrinol 17(1):102. https:\/\/doi.org\/10.1186\/s12958-019-0549-9","journal-title":"Reprod Biol Endocrinol"},{"key":"8229_CR13","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.837880","volume":"13","author":"E Kalafat","year":"2022","unstructured":"Kalafat E, Turkgeldi E, Yildiz S, Dizdar M, Keles I, Ata B (2022) Outcomes of a GnRH agonist trigger following a GnRH antagonist or flexible progestin-primed ovarian stimulation cycle. Front Endocrinol (Lausanne) 13:837880. https:\/\/doi.org\/10.3389\/fendo.2022.837880","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"5","key":"8229_CR14","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1016\/j.fertnstert.2019.12.024","volume":"113","author":"D Dozortsev","year":"2020","unstructured":"Dozortsev D, Pellicer A, Diamond MP (2020) Progesterone is a physiological trigger of ovulatory gonadotropins. Fertil Steril 113(5):923\u2013924. https:\/\/doi.org\/10.1016\/j.fertnstert.2019.12.024","journal-title":"Fertil Steril"},{"issue":"2","key":"8229_CR15","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jogoh.2018.10.008","volume":"48","author":"P Huang","year":"2019","unstructured":"Huang P, Tang M, Qin A (2019) Progestin-primed ovarian stimulation is a feasible method for poor ovarian responders undergoing in IVF\/ICSI compared to a GnRH antagonist protocol: a retrospective study. J Gynecol Obstet Hum Reprod 48(2):99\u2013102. https:\/\/doi.org\/10.1016\/j.jogoh.2018.10.008","journal-title":"J Gynecol Obstet Hum Reprod"},{"issue":"6","key":"8229_CR16","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1016\/j.fertnstert.2024.01.027","volume":"121","author":"ZQ Chen","year":"2024","unstructured":"Chen ZQ, Ai A, Zhang Y, Li H, Wang JY, Wang L et al (2024) A randomized controlled trial to compare the live birth rate of the first frozen embryo transfer following the progestin-primed ovarian stimulation protocol vs. the antagonist protocol in women with an anticipated high ovarian response. Fertil Steril 121(6):937\u2013945. https:\/\/doi.org\/10.1016\/j.fertnstert.2024.01.027","journal-title":"Fertil Steril"},{"key":"8229_CR17","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.ejogrb.2023.12.035","volume":"294","author":"A Vaiarelli","year":"2024","unstructured":"Vaiarelli A, Cimadomo D, Ruffa A, Rania E, Pittana E, Gallo C et al (2024) Oocyte competence is comparable between progestin primed ovarian stimulation with Norethisterone acetate (NETA-PPOS) and GnRH-antagonist protocols: a matched case-control study in PGT-A cycles. Eur J Obstet Gynecol Reprod Biol 294:4\u201310. https:\/\/doi.org\/10.1016\/j.ejogrb.2023.12.035","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"1","key":"8229_CR18","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1002\/ijgo.15543","volume":"167","author":"M Wang","year":"2024","unstructured":"Wang M, Li L, Zhu H, Wang R, Liu R, Zhang H (2024) Comparison of progestin-primed ovarian stimulation regimen and antagonist regimen in women aged 35 years or older with diminished ovarian reserve: a propensity score-matched study. Int J Gynaecol Obstet 167(1):162\u2013168. https:\/\/doi.org\/10.1002\/ijgo.15543","journal-title":"Int J Gynaecol Obstet"},{"issue":"8","key":"8229_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/j.isci.2023.107357","volume":"26","author":"Y Xie","year":"2023","unstructured":"Xie Y, Guo W, Shen X, Yu W, Kuang Y, Chen Q et al (2023) A delayed ovulation of progestin-primed ovarian stimulation (PPOS) by downregulating the LHCGR\/PGR pathway. iScience 26(8):107357. https:\/\/doi.org\/10.1016\/j.isci.2023.107357","journal-title":"iScience"}],"container-title":["Archives of Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-025-08229-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00404-025-08229-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00404-025-08229-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T13:08:04Z","timestamp":1765804084000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00404-025-08229-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,29]]},"references-count":19,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["8229"],"URL":"https:\/\/doi.org\/10.1007\/s00404-025-08229-7","relation":{},"ISSN":["1432-0711"],"issn-type":[{"value":"1432-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,29]]},"assertion":[{"value":"15 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This retrospective study was approved by the Bahceci Institutional Ethics Board (application number: 158), and conducted in accordance with the principles of the Declaration of Helsinki. The requirement for informed consent was waived due to the retrospective nature of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}