Dydrogestrone-Primed Stimulation Protocol versus Conventional Antagonist Protocol in Polycystic Ovarian Syndrome Cases Undergoing ICSI

Ovarian stimulation protocols significantly impact in vitro fertilization (IVF) outcomes, with concerns of luteinizing hormone (LH) surges and ovarian hyperstimulation syndrome (OHSS). Progesterone-primed ovarian stimulation (PPOS) protocols, including the use of synthetic progestin like dydrogesterone, have shown promise as LH surge prevention alternatives. This study aimed to compare Dydrogesterone and GnRH Antagonist treatments by assessing the incidence of premature LH surges and the total number of mature oocytes retrieved in PCOS patients. Methods: This prospective comparative study was conducted at Benha University Hospital, involving 60 PCOS patients who met the inclusion criteria. Patients were divided into two groups: DYD group (received dydrogesterone medication) and CET group (received cetrorelix medication). Ovarian stimulation was initiated with recombinant FSH. Oocyte maturation was triggered using a GnRH agonist. Embryos were evaluated, vitrified, and warmed. Endometrial preparation and frozen embryo transfer (FET) were performed as per protocol. Results: There was no statistically significant difference in the number of mature oocytes between the CET and DYD groups (p-value = 0.620). The LH levels on trigger day are comparable between the groups (p-value = 0.191). Conclusion: Both protocols are effective in terms of achieving a similar number of mature oocytes, fertilization rates, and low incidences of OHSS. However, the Dydrogestrone protocol demonstrated a shorter duration of ovarian stimulation and a lower total gonadotropin dose compared to the Antagonist Protocol.