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

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).