IVF Outcomes After PPOS Versus Flexible GnRH‐Antagonist Protocol in Advanced‐Age Women With Diminished Ovarian Reserve: A Retrospective Study

Background: Infertility affects 8%-12% of couples worldwide; advanced maternal age combined with diminished ovarian reserve (DOR) significantly lowers IVF success. The flexible GnRH-antagonist and progestin-primed ovarian stimulation (PPOS), are increasingly adopted for freeze-all strategies in this poor-prognosis population; however, their relative effectiveness remains inconclusive. Methods: This retrospective study (January 2017-April 2022) enrolled only women ≥ 35 years with diminished ovarian reserve (AMH < 1.2 ng/mL and/or AFC < 5). Two controlled ovarian stimulation protocols were compared: the flexible GnRH-ant protocol and the PPOS protocol. The participants were matched using propensity score matching (PSM) based on age, body mass index (BMI), anti-Müllerian hormone (AMH) level, and antral follicle count (AFC). We compared the ovarian responses to controlled ovarian stimulation treatments and assessed the pregnancy outcomes after FET between the two groups. Results: < 0.001). Conclusion: Although the quality and quantity of the embryos was different, the good-quality embryo rate and pregnancy outcomes were similar in FET cycles between the flexible GnRH-ant protocol and PPOS protocol in advanced maternal age with DOR.