Comparing IVF Outcomes of Progestin Primed Ovarian stimulation(PPOS) with Ultrashort flare(USF)GnRH Agonist in Expected Poor responders(POSEIDON 3,4)-A Multicentric Randomised controlled Trail

Poor responders constitute approximately 47% of assisted reproductive technology (ART) patients. With the increasing delay in childbearing, POSEIDON group 4 seems to increase constituting more than 50% of the total POSEIDON population, whereas group 3 patients constitute approximately 10%(1). Inspite of various treatment options available, there are lack of good quality studies to suggest the stimulation protocol for better results in women with poor ovarian reserve .Also ,need for multiple stimulations for pooling up of embryos also make cost as concern. The recommendations from ESHRE regarding the use of PPOS for IVF stimulation are conditional, emphasizing the need for more robust and high-quality studies.However, limited data were available to compare the efficacy of PPOS and Ultrashort flare GnRH agonist protocol in expected poor responders.

There are previous studies comparing ppos with GnRH antagonist protocol retrospectively with no difference in CLBR  by Zhang et al in china (2)

But there were no randomised controlled trails in poseidon population comparing ppos with ultra short flare GnRH agonist protocol

so we need a Randomized controlled trial to investigate the potential of PPOS and USF GnRH agonist protocol used for the poor responders undergoing IVF/ICSI treatment to suggest better stimulation in terms of cost , compliance and IVF outcomes.

1.Conforti A, Esteves SC, Picarelli S, Iorio G, Rania E, Zullo F, et al. Novel approaches for diagnosis and management of low prognosis patients in assisted reproductive technology: the POSEIDON concept. Panminerva Med. (2019) 61:24–9. 10.23736/S0031-0808.18.03511-5 [DOI] [PubMed] [Google Scholar]

2.Zhang S, Yin Y, Li Q, Zhang C. Comparison of Cumulative Live Birth Rates Between GnRH-A and PPOS in Low-Prognosis Patients According to POSEIDON Criteria: A Cohort Study. Front Endocrinol (Lausanne). 2021 Jun 21;12:644456. doi: 10.3389/fendo.2021.644456. PMID: 34234739; PMCID: PMC8256850.