“One Size does not Fit All” during Ovarian Stimulation for IVF

Ovarian stimulation (OS) is the heart of IVF. Various OS protocols are developed and many of them are still being explored to provide an individualized approach, making the care more patient-centric. Premature LH surge is one of the potential side effects accompanying the OS, and to prevent this phenomenon either GnRH analogs or progesterone are being used. The following case report is of a PCOS patient undergoing COS using progesterone-primed ovarian stimulation (PPOS) which was modified by adding GnRH antagonist in the middle of stimulation due to accelerated growth of a single follicle in one ovary. The premature luteinization was prevented and the stimulation cycle was salvaged, giving a good outcome in terms of mature oocyte, grade of embryos, and pregnancy. This case report emphasizes the importance of strict monitoring as well as an individualization of each stimulation cycle to case to case basis for achieving the best outcome.