Comparison of pregnancy outcomes and safety between cetrorelix and ganirelix in IVF/ICSI antagonist protocols: a retrospective cohort study

Xinyue Peng; Xingyu Lv; Penghao Li; Yingxing Li; Yuling Hu; Yi Zhang; Yuan Li

doi:10.3389/frph.2025.1492441

Comparison of pregnancy outcomes and safety between cetrorelix and ganirelix in IVF/ICSI antagonist protocols: a retrospective cohort study

Front Reprod Health. 2025 Apr 14:7:1492441. doi: 10.3389/frph.2025.1492441. eCollection 2025.

Authors

Xinyue Peng¹, Xingyu Lv¹, Penghao Li^{1

2}, Yingxing Li¹, Yuling Hu¹, Yi Zhang¹, Yuan Li¹

Affiliations

¹ Department of Reproductive Medicine, Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, Sichuan, China.
² Department of Scientific Research and Education, Chengdu Jinxin Research Institute for Reproductive Medicine and Genetics, Chengdu, Sichuan, China.

Abstract

Introduction: This study aimed to compare the safety, efficacy, and clinical predictors of live birth outcomes between cetrorelix and ganirelix in GnRH antagonist protocols during controlled ovarian stimulation.

Methods: In this retrospective cohort study conducted at a reproductive medicine center (June 2019-June 2022), 2,365 patients receiving cetrorelix (Group A) and 7,059 patients receiving ganirelix (Group B) were analyzed after 1:3 propensity score matching. Outcomes included LH surge suppression, OHSS incidence, endometrial morphology, embryological parameters, and live birth rates. Multivariate logistic regression identified independent predictors of clinical success.

Results: Cetrorelix demonstrated superior LH surge control, with lower incidences of LH ≥10 U/L (4.9% vs. 7.6%, p < 0.001) and LH ratio(trigger day LH Gn day LH) ≥2 (6.1% vs. 9.2%, p < 0.001). Endometrial receptivity was more favorable in Group A, with higher Type A (66.2% vs. 60.1%) and lower Type C morphology (5.3% vs. 6.3%, p < 0.001). Ganirelix showed a higher overall OHSS incidence (1.1% vs. 0.4%, p = 0.01). Live birth rates were comparable (47.2% vs. 49.4%, p = 0.074). Multivariate analysis revealed advanced female age (≥35 years) reduced success (aOR = 0.65, 95% CI 0.57-0.74, p < 0.001), while AMH ≥4 μg/L (aOR = 1.29, 95% CI 1.02-1.64, p = 0.034), and dual embryo transfer (aOR = 1.51, 95% CI 1.38-1.65, p < 0.001) improved outcomes.

Conclusion: Cetrorelix and ganirelix demonstrate comparable live birth rates and embryo quality, yet exhibit distinct safety profiles. Cetrorelix provides superior LH surge suppression and reduced OHSS risk, making it preferable for high-risk patients, while ganirelix may serve cases requiring rapid LH control. Cetrorelix offering enhanced endometrial receptivity (66.2% Type A morphology) and safety advantages. These findings support cetrorelix's role in optimizing ART safety without compromising efficacy.

Keywords: cetrorelix; controlled ovarian stimulation; ganirelix; gonadotropin-releasing hormone antagonist; live birth rate.