Progestin Primed Ovarian Stimulation with Dydrogesterone as an Oral Alternative to the Conventional GnRH Antagonist Protocol in Infertile PCOS Women Undergoing IVF: A Retrospective Study in Egypt

Objective: To determine whether the progestin primed ovarian stimulation (PPOS) protocol using dydrogesterone (DYG) is comparable to the gonadotropin antagonist (GnRH ant) protocol in regards to effectiveness and safety, when used in infertile polycystic ovarian syndrome (PCOS) patients undergoing IVF.Study Design: A retrospective cohort study consisting of 60 infertile women with PCOS who underwent IVF or ICSI, with equal numbers using the PPOS or GnRH ant protocols followed by cryopreservation of all embryos from April 2021 to May 2022. Primary outcome was the number of oocytes retrieved. Other outcomes included the duration and total dose of gonadotropins used, the mature metaphase II oocyte counts retrieved, fertilisation rates and viable embryo rates in both groups. The rate of OHSS in both groups were also compared.Results: Both groups were comparable in terms of age, body mass index (BMI), duration of infertility and baseline levels of anti-mullerian hormone (AMH). Both groups were also comparable in terms of the number oocytes retrieved (27.37 ± 5.37 for PPOS vs 28.87 ± 5.91 for GnRH-ant protocol). Although the number of 2PN fertilized oocyte was significantly less in the PPOS group than the GnRH ant group (14.07±3.17 vs 16.67±3.24, P <0.005), the 2PN fertilization rate and the high-quality embryos cryopreserved (8.67 ± 2.99 for PPOS vs 9.3± 2.89 for GnRH-ant protocol) were similar between the two groups. The number of women that experienced mild and moderate OHSS were comparable in both groups.Conclusion: In comparison to the conventional GnRH ant protocol, PPOS protocol using DYG provides an effective management option with similar clinical outcomes and a good safety profile.