Blossoming tree of life symbolizing IVF success.

Unlock Your Fertility Potential: How GnRH Agonist Trigger and Embryo Freezing Can Help High Responders

Nico Varela in Health & Wellness December 2025 • 4 min read.

"A groundbreaking study reveals the cumulative success of GnRH agonist triggers and elective embryo cryopreservation for women at risk of OHSS, offering new hope for achieving pregnancy."

For many couples, the path to parenthood involves navigating the complexities of assisted reproductive technology (ART). As advancements in reproductive medicine continue to evolve, new strategies emerge to improve the safety and success of in vitro fertilization (IVF). One such strategy gaining traction is the use of gonadotropin-releasing hormone (GnRH) agonist triggers combined with elective or 'freeze-all' embryo cryopreservation.

Ovarian hyperstimulation syndrome (OHSS) remains a significant concern for women undergoing ovarian stimulation, particularly those who are considered high responders. This potentially life-threatening condition arises from an excessive response to fertility medications. Traditionally, GnRH antagonist protocols have been favored over GnRH agonist protocols to mitigate this risk. However, GnRH antagonist protocols allow for additional measures, like triggering final oocyte maturation using a GnRH agonist.

A recent study published in Reproductive BioMedicine Online sheds light on the cumulative live birth rates achieved through this approach. By electively freezing all embryos and transferring them in subsequent menstrual cycles, researchers have demonstrated promising outcomes for high-responding patients. This article explores the findings of this study and what it means for women undergoing IVF.

What is GnRH Agonist Triggering and Elective Embryo Cryopreservation?

Blossoming tree of life symbolizing IVF success.

To understand the significance of the study, it's important to define the key concepts involved. In a typical IVF cycle, medications are used to stimulate the ovaries to produce multiple eggs. Once the eggs are mature, a 'trigger shot' is administered to induce final oocyte maturation, the last step before egg retrieval. Human chorionic gonadotropin (hCG) has traditionally been used as the trigger. However, in GnRH agonist triggering, a GnRH agonist is used instead.

Elective embryo cryopreservation, also known as the 'freeze-all' strategy, involves freezing all viable embryos after fertilization instead of transferring them to the uterus in the same cycle. The frozen embryos are then transferred in subsequent, more natural menstrual cycles. Vitrification, a rapid freezing technique, has revolutionized embryo cryopreservation, resulting in significantly improved survival rates.

Reduced Risk of OHSS: GnRH agonist triggers nearly eliminate the risk of OHSS.
Improved Endometrial Receptivity: Freezing embryos allows the uterus to return to a more natural state, potentially improving the chances of implantation.
Better Workload Management: Clinics can better manage their resources and schedules by separating the stimulation and transfer phases.
Improved Obstetrical Outcomes: Some studies suggest better obstetrical and neonatal outcomes with frozen-thawed embryo transfers.

The study aimed to evaluate the cumulative probability of achieving a live birth through consecutive transfers of vitrified-warmed blastocysts after applying the freeze-all strategy in high-responding patients. Researchers conducted a single-center retrospective study involving 123 women identified as high risk for developing OHSS. These women underwent IVF with a GnRH antagonist protocol, and a GnRH agonist was used to trigger final oocyte maturation. All embryos were vitrified at the blastocyst stage and transferred in subsequent menstrual cycles.

What Does This Mean for Your Fertility Journey?

If you're a high responder undergoing IVF, these findings offer a reassuring perspective. The combination of GnRH agonist triggering and elective embryo cryopreservation can significantly reduce the risk of OHSS while maintaining high cumulative live birth rates. Discuss this strategy with your fertility specialist to determine if it's the right approach for you.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.rbmo.2017.03.017, Alternate LINK

Title: Cumulative Live Birth Rate After Gnrh Agonist Trigger And Elective Cryopreservation Of All Embryos In High Responders

Subject: Developmental Biology

Journal: Reproductive BioMedicine Online

Publisher: Elsevier BV

Authors: Veljko Vlaisavljević, Borut Kovačič, Jure Knez

Published: 2017-07-01

Everything You Need To Know

What is the role of GnRH agonist triggering in IVF, and how does it differ from traditional methods?

In IVF, the final step before egg retrieval involves inducing oocyte maturation, often triggered by Human Chorionic Gonadotropin (hCG). However, GnRH agonist triggering substitutes hCG with a GnRH agonist to promote oocyte maturation. This method is particularly beneficial because it significantly reduces the risk of Ovarian Hyperstimulation Syndrome (OHSS), a major concern for high responders, by preventing the excessive hormonal surge associated with traditional triggers.

How does elective embryo cryopreservation, or the 'freeze-all' strategy, contribute to improved outcomes in IVF, and what are its advantages?

Elective embryo cryopreservation involves freezing all embryos after fertilization and transferring them in subsequent cycles. This strategy improves endometrial receptivity as it allows the uterus to return to a more natural state. Advantages include better management of clinic resources and schedules by separating stimulation and transfer phases. Moreover, it has been associated with improved obstetrical and neonatal outcomes in some studies, offering significant benefits for women undergoing IVF.

Who are 'high responders' in the context of IVF, and why is the combination of GnRH agonist triggering and embryo cryopreservation particularly beneficial for them?

High responders in IVF are women whose ovaries overreact to stimulation medications, increasing the risk of OHSS. GnRH agonist triggering and elective embryo cryopreservation are particularly beneficial for them. GnRH agonist triggers mitigate OHSS risk, while cryopreservation allows for controlled embryo transfer in later cycles, improving endometrial receptivity and potentially increasing cumulative live birth rates. This combination offers a safer and more effective approach for high responders undergoing IVF.

What were the key findings of the study on GnRH agonist triggers and embryo cryopreservation, and what implications do they have for women undergoing IVF?

The study demonstrated improved cumulative live birth rates through the use of GnRH agonist triggers and elective embryo cryopreservation in high-responding patients. By freezing all embryos and transferring them in subsequent menstrual cycles, researchers achieved promising outcomes. This means that women at risk of OHSS can pursue IVF with greater confidence, knowing that this approach can maintain high success rates while significantly reducing health risks. These findings offer a reassuring perspective, suggesting this combined strategy can offer a safer and more effective path to pregnancy.

Can you explain the process of vitrification and how it has revolutionized embryo cryopreservation in the context of IVF?

Vitrification is a rapid freezing technique used in embryo cryopreservation. It involves the quick cooling of embryos to very low temperatures, which prevents the formation of ice crystals that can damage the cells. This method has revolutionized embryo cryopreservation because it leads to significantly improved survival rates of the embryos after thawing. The higher survival rates are crucial for the success of IVF, as they increase the chances of a successful embryo transfer and ultimately, a live birth.