PPOS: Innovative Approach to Ovarian Stimulation
PPOS (Progestin-primed Ovarian Stimulation) is a novel approach to stimulating ovulation in women undergoing procedures such as egg freezing or in-vitro fertilization (IVF).
To ensure an adequate number of mature eggs for fertilization or egg freezing, the conventional method involves administering two groups of medications: 1) gonadotropins, which stimulate the development of multiple follicles, and 2) GnRH agonists or GnRH antagonists, which prevent premature ovulation. Both groups of medications are administered via injections.
Research conducted across multiple countries, including Thailand, has pinpointed a significant barrier leading many women to decline assisted reproductive technology treatments such as IVF or egg freezing. This barrier stems from the need for multiple injections over several consecutive days. As a result, there has been substantial focus on developing alternative methods for ovarian stimulation to minimize the number of injections while maintaining a high level of treatment efficacy.
In response to the aforementioned needs of patients, there has been a concerted effort to develop orally administered medications for preventing premature ovulation. One such oral medication is progestin, which is widely regarded as safe due to its common use in pregnant women. Progestin functions by regulating the activity of pituitary gland and inhibiting the production of luteinizing hormone (LH) that triggers ovulation. The mechanisms of progestin have been widely studied, particularly in the context of progestogen-only contraceptive pills.
However, the use of progestin to prevent premature ovulation may have an adverse impact on the quality of the endometrium during its administration cycle, rendering it unsuitable for pregnancy. Consequently, individuals undergoing progestin treatment will not be able to undergo embryo transfer during their ovarian stimulation cycle. Nonetheless, the adverse effects on the endometrium do not persist in subsequent cycles once the endometrium has shed during menstruation.
Ovarian stimulation using the PPOS protocol involves patients commencing progestin intake at the start of ovarian stimulation and continuing until the cycle’s end. This regimen is combined with daily or weekly injections of medications for ovarian stimulation. By selecting an extended-release medication that remains effective in stimulating ovulation for 7 days with a single injection, the number of injections required per treatment cycle is significantly reduced, from the typical 15-20 to just 2-6 injections. Additionally, the PPOS protocol decreases the frequency of blood tests necessary for monitoring during ovarian stimulation.
Jetanin Hospital’s fertility center has been implementing the PPOS protocol for ovarian stimulation in patients for over 2 years. Comprehensive data have been gathered to validate the efficacy of PPOS treatment, which aligns closely with conventional methods of ovarian stimulation, particularly in terms of the number of eggs retrieved, fertilization rate, embryo quality, and pregnancy rate from PPOS-induced eggs. Safety data concerning the risk of ovarian hyperstimulation syndrome (OHSS) have also been collected. These findings were presented at the Pacific Society for Reproductive Medicine 2023 conference in Sydney, Australia.
The PPOS protocol is suitable for patients with normal ovarian function who do not intend to undergo embryo transfer during the stimulation cycle, such as those planning to undergo preimplantation genetic testing or embryo or egg freezing for future use.
Please consult with your attending physician to determine whether the PPOS protocol is suitable for you.
Reference :
Jetanin Hospital PPOS: Innovative Approach to Ovarian Stimulation
Jetanin Hospital
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