In a nutshell
This study evaluated the effectiveness of progestin-primed ovarian stimulation (PPOS) protocol for infertile patients with different ovarian reserve functions. The data showed that PPOS is an effective ovarian stimulation protocol and is beneficial for these patients.
Many couples with infertility opt to use assisted reproductive techniques (ART). In vitro fertilization (IVF) is an ART in which eggs are collected and fertilized embryos are implanted in the uterus. The first step of IVF is to stimulate the ovaries to produce multiple eggs for collection. However, women with poor ovarian response do not produce many eggs in response to ovarian stimulation.
Two methods are commonly used. These are GnRH agonist and GnRH antagonist protocols. GnRH is a chemical produced by the brain to stimulate the ovaries to release oocytes (eggs). The GnRH agonist protocol takes a longer period of time but may improve the body’s own level of hormones such as follicle-stimulating hormone (FSH). FSH promotes ovarian follicle development. GnRH antagonist is the other commonly used option to reduce luteinizing hormone (LH) levels (another hormone needed for follicle production and maturation). This protocol takes a shorter period of time and may be gentler for women with a poor ovarian response. It also allows the option to use GnRH agonist as the trigger injection before egg collection.
Recently, a new procedure for ovarian stimulation has been introduced. Progestin-primed ovarian stimulation (PPOS) uses progestin (a synthetic female hormone) to stimulate the ovaries. PPOS is a new ovarian stimulation protocol that can block the LH surge through progesterone instead of traditional GnRH. PPOS also has a lower risk of ovarian hyperstimulation syndrome (OHSS). This is a major complication of ovarian stimulation that can lead to the loss of an ovary. However, the effectiveness of the PPOS protocol for infertile patients with different ovarian reserve functions is still unknown.
Methods & findings
This study analyzed 9 studies and involved women with different ovarian reserve functions. 942 patients received the PPOS protocol. 943 patients received the control protocol.
There were no significant differences in the clinical pregnancy rates and live birth or ongoing pregnancy rates between the two groups.
In patients with diminished ovarian reserve (DOR), the PPOS protocol had a lower rate of premature LH surge compared to the control protocol. The PPOS protocol had a lower rate of ovarian OHSS compared to the control protocol.
The PPOS protocol had a higher number of oocytes collected, a higher number of more mature oocytes, and higher viable embryos compared to the control protocol in patients with DOR and normal ovarian reserve (NOR).
The bottom line
This study concluded that PPOS is an effective ovarian stimulation protocol and is beneficial for patients with different ovarian reserve functions.
The fine print
This study looked back in time at medical records. The sample size was very small. This study did not directly compare the impact of different stimulation protocols on treatment effects.
Published By :
Frontiers in Endocrinology
Sep 18, 2021