O-258 Progestin-primed ovarian stimulation: Comparing the LH suppression efficacy of oral micronized progesterone and dydrogesterone

Abstract Study question Is Progestin-Primed Ovarian Stimulation (PPOS) with oral micronized progesterone more effective in suppressing the LH surge compared to dydrogesterone? Summary answer In young women, ovarian stimulation for in vitro fertilization (IVF) using the PPOS protocol with oral micronized progesterone produced comparable results to dydrogesterone. What is known already In recent years, the PPOS ovarian stimulation protocol has been shown to effectively prevent premature ovulation in IVF cycles while remaining safe and more cost-effective than conventional protocols. PPOS with dydrogesterone is widely used by clinicians; however, the use of micronized progesterone seems to be effective, albeit controversial. Study design, size, duration This retrospective observational study analyzed data from 110 patients under 40 years of age undergoing IVF at a single center between August 2024 and December 2024. Among them, 55 patients received oral dydrogesterone (Duphaston) at 30 mg three times per day, while 55 patients received oral micronized progesterone (Utrogestan) at 200 mg once per day. Participants/materials, setting, methods All women under 40 years of age undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with PPOS were administered either Duphaston or Utrogestan to suppress the LH surge. Main results and the role of chance Baseline characteristics were similar between the two groups. The Utrogestan group exhibited significantly higher LH concentration progression (Day 6: 6.64±3.65 vs. 5.20±2.53, p < 0.05; trigger day: 4.24±2.55 vs. 3.34±1.66, p < 0.05). Nine patients in the Utrogestan group required a switch to the antagonist regimen, compared to five in the Duphaston group. The Pittsburgh Sleep Quality Index in the Utrogestan group showed a slight decrease, though not statistically significant (4.00±1.78 vs. 4.12±2.02, p = 0.761). Both regimens yielded similar outcomes in terms of total oocytes retrieved (14.27±7.78 vs. 14.40±10.77, p = 0.943) and the number of good-quality embryos on Day 3 (5.49±4.95 vs. 5.87±6.22, p = 0.722). No adverse drug reactions were observed. Limitations, reasons for caution As this is a retrospective observational study, a longer follow-up period is needed to assess pregnancy outcomes and observe a larger patient cohort. Wider implications of the findings This study demonstrates that oral micronized progesterone is a safe and cost-effective alternative to traditional dydrogesterone for suppressing the LH surge during ovarian stimulation in IVF. Trial registration number No