# Implications of Progestin-Primed Ovarian Stimulation (PPOS) in a Patient With Diminished Ovarian Reserve (DOR) and Its In Vitro Fertilization (IVF) Outcome

## TL;DR

A 39-year-old woman with poor ovarian reserve achieved a successful pregnancy using a modified progestin-based ovarian stimulation method after previous IVF failures.

## Contribution

Demonstrates the potential of progestin-primed ovarian stimulation in improving IVF outcomes for patients with diminished ovarian reserve.

## Key findings

- Initial IVF attempts failed due to no fertilization and poor oocyte retrieval.
- Progestin priming led to a successful clinical pregnancy outcome.
- The modified protocol improved endometrial readiness for embryo implantation.

## Abstract

In this case study, a 39-year-old woman pursuing treatment for secondary infertility at our infertility clinic was visited by her 42-year-old husband. The couple had a history of failed attempts, including two intrauterine insemination (IUI), two intracytoplasmic sperm injection (ICSI) cycles, and two miscarriages. Diminished ovarian reserve (DOR) was noted in the patient's medical profile. A gonadotropin-releasing hormone (GnRH) antagonist, cetrorelix acetate, was given to the patient at a daily dosage of 0.25 mg to treat their condition once the maturing follicle had grown to a diameter of 10 mm.

Following the administration of the GnRH antagonist, the first oocyte pick-up (OPU) procedure was conducted. During this process, two oocytes were successfully retrieved. Subsequently, ICSI was performed to facilitate fertilization. However, during the fertilization check, it was observed that no pronuclear fertilization (PN) formations occurred, leading to a cessation of development. Following the initial failure, an ovarian stimulation strategy based on progestin priming was implemented. Progestin is administered using this technique to ready the endometrium for the implantation of the embryo. After the modified ovarian stimulation protocol, an additional beta-human chorionic gonadotropin (β-hCG) test was verified as a successful clinical pregnancy outcome.