Treatment outcomes using different progesterones for external fertilization-embryo transfer with progestin primed ovarian stimulation (PPOS) in patients with poor ovarian response

Objective: This study analyzed the outcomes obtained using different progesterone treatments with external fertilization-embryo transfer and progestin primed ovarian stimulation (PPOS) in patients with poor ovarian response. This study also explored the value of dydrogesterone in the PPOS protocol for patients with a poor ovarian response. Methods: The clinical data obtained from patients with poor ovarian responses who underwent in vitro fertilization-embryo transfer IVF-ET in the Zaozhuang Maternal and Child Healthcare Hospital from 2017 to 2019 were retrospectively analyzed. Ovulation was induced using PPOS. The hormone levels, medication status, and clinical outcomes were compared between patients who received medroxyprogesterone acetate as the progesterone treatment (MPA group) and patients who received dydrogesterone as the progesterone treatment (DYG group). Results: There were no significant differences in the basic characteristics between the MPA group and DYG group (P>0.05). There were no significant differences between the two groups in the number of retrieved oocytes, 2PN rate, and non-transplantable embryo cycle rate (P<0.05). With respect to the thawing cycle, the DYG group exhibited a trend towards higher clinical pregnancy and implantation rates, but the differences did not reach statistical significance (P>0.05). There were no significant differences in early spontaneous abortion and multiple pregnancy rates between the two groups (P>0.05). Also, no triplet or ectopic pregnancies were observed in either group. Conclusion: Dydrogesterone can effectively suppress LH peaks and prevent premature ovulation when used in the PPOS protocol, and it is a safer drug than MPA. Thus, dydrogesterone could be used in place of medroxyprogesterone acetate in PPOS for patients with poor ovarian response.