Publication:

A randomized study comparing flexible PPOS with flexible GnRH antagonist protocol in IVF outcomes

Background To compare clinical efficacy of flexible PPOS and flexible GnRH antagonist protocol in ART.

Methods A prospective randomized controlled study was conducted at RIDGE IVF Centre, Delhi, from July 2024 to June 2025. 100 women with normal ovarian reserve, aged 21–40 years, undergoing IVF/ICSI were randomly assigned to Group A (fPPOS, n=50) or Group B (flexible GnRH antagonist, n=50). Primary outcomes were number of oocytes retrieved, mature oocytes (MII), embryo formation, embryo quality on day 3 and day 5. Gonadotropin dosage, stimulation duration and clinical pregnancy rates were secondary outcomes.

Results The two groups shared comparable baseline characteristics, including age, BMI, type of infertility and infertility duration. Although day 2 FSH levels were lower in Group A, serum AMH and AFC levels were comparable in both groups. The number of oocytes retrieved, MII oocytes and embryos formed were comparable (p>0.05). In either protocol, there were no instances of premature luteinization. On day 3 and day 5, neither the quality/distribution of the embryos differed significantly (p>0.05). Both groups had comparable clinical pregnancy rates (p=1.0) and  β-hCG positivity rates (50 percent vs. 42 percent, p=0.42). There were no significant differences in duration of stimulation or total dose of gonadotropin used. No cases of OHSS were reported.

Conclusions In IVF cycles, flexible PPOS and flexible GnRH antagonist protocols have comparable clinical and embryological outcomes. Flexible PPOS is a viable, patient-friendly alternative for frozen- embryo transfer cycles.