Taarika Ramesh: Rethinking IVF Stimulation With Progestin-Primed Protocols
Taarika Ramesh, Junior Resident at Vardhman Mahavir Medical College, shared a post on LinkedIn:
“When Progesterone Leads the Protocol: Rethinking Ovarian Stimulation in IVF
The Progestin Primed Ovarian Stimulation (PPOS) approach is quietly reshaping how we manage controlled ovarian stimulation.
Traditionally, preventing premature LH surge meant relying on GnRH analogues. But PPOS challenges that paradigm by using oral progestins to achieve the same goal, with surprising efficiency.
How it works:
Progestins suppress the HPO axis, effectively preventing premature LH surge during stimulation, without the need for GnRH antagonists.
Why it matters:
- Simplifies protocols (oral medication, fewer injections)
- Cost-effective alternative in resource conscious settings
- Particularly useful in poor responders and fertility preservation cycles
- Aligns well with a freeze-all strategy.
Protocol Snapshot:
Day 2–3:
- Start Gonadotropins
- + Oral progestin
Monitoring → TVS + E2
Trigger → GnRH agonist / hCG
OPU → Freeze all embryos
Limitations:
Endometrial advancement under progesterone makes fresh embryo transfer unsuitable ,making vitrification essential.
Emerging perspective:
With advancements in cryopreservation, especially vitrification, the ‘freeze-all’ strategy is no longer a limitation,but a strategic advantage.
Clinical takeaway:
PPOS is not just an alternative but a paradigm shift in selected IVF populations, emphasizing flexibility, patient comfort, and individualized care.”
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