# Progesterone Primed Ovarian Stimulation (PPOS) vs. clomiphene Primed Ovarian Stimulation (CPOS) in high responder (HR) patients undergoing controlled ovarian stimulation. A Randomised Control trial

## TL;DR

A study compared two ovarian stimulation methods in high-responder patients undergoing IVF and found similar outcomes except for lower LH levels in one group.

## Contribution

The study provides evidence that PPOS and CPOS yield comparable results in high-responder IVF patients, with PPOS showing lower post-trigger LH levels.

## Key findings

- PPOS and CPOS showed no significant differences in LH surge, cycle cancellation rates, birth rates, or implantation rates.
- Post-trigger LH levels were significantly lower in the PPOS group compared to CPOS.
- Neither group experienced ovarian hyperstimulation syndrome (OHSS).

## Abstract

To compare the efficacy and safety of PPOS and CPOS in high-responder
patients undergoing COS for IVF.

This one-year prospective, randomized, controlled trial included 86
high-responder patients. They were divided into PPOS (n=44) and CPOS (n=42).
Both groups underwent COS with hormonal injections, and various parameters,
such as LH surge, cycle cancellation rates, birth rates, implantation rates,
and more, were measured and compared.

The study revealed that LH surge occurred in 2.3% of the PPOS group and 2.5%
of the CPOS group, with no significant difference (p=0.9).
The cycle cancellation rates were 9.1% for PPOS and 10% for CPOS. Birth
rates were 57% for PPOS and 54% for CPOS. Implantation rates were 45% for
PPOS and 49% for CPOS. There was no significant difference in the duration
of stimulation (PPOS: 11.30±1.96 days, CPOS: 11.41±2.02 days,
p=0.807) or the total FSH used (PPOS:
2888.95±791.80IU, CPOS: 2808±834.52IU,
p=0.655). The PPOS group had a mean of 19.58±8.07
retrieved oocytes, while the CPOS group had a mean of 21.87±10.02,
showing no significant difference (p=0.807). Similarly,
there was no significant difference (p=0.376) in the number
of mature (MII) oocytes between the PPOS group (15.67±6.23) and the
CPOS group (17.08±7.96). Post-trigger LH levels were significantly
lower in the PPOS group (PPOS: 49.68±27.54IU/L, CPOS:
71.83±43.43IU/L, p-value 0.007), indicating LH surge
suppression. Neither group reported cases of ovarian hyperstimulation
syndrome (OHSS).

PPOS and CPOS offer similar outcomes in high-responder individuals undergoing
COS for IVF, except for lower post-trigger LH levels in the PPOS group.
Importantly, neither group experienced ovarian hyperstimulation syndrome
(OHSS).