Dydrogesterone is an eligible tool to suppress LH surge in assisted reproduction technologies (ART) cycles

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OBJECTIVE: To evaluate Dydrogesterone's effectiveness in PPOS protocols for IVF/ICSI or oocyte cryopreservation, focusing on LH surge suppression and metaphase II oocyte yield. METHODS: A retrospective, comparative, single-center study of 550 IVF/ICSI and 186 oocyte cryopreservation cycles was conducted from January 2018 to December 2020. Exclusion criteria included endometriosis, previous ovarian surgery, ovarian insufficiency, and abnormal FSH/LH levels. Patients received either Follitropin delta (Rekovelle®) or Menotropin (Menopur®). LH surge blockade was achieved with GnRH antagonist (Cetrotide®) or DYG (Duphaston®). Primary outcome was incidence of premature LH surge; secondary outcomes included follicle size on hCG day, metaphase II oocytes, cancelled cycles, and OHSS. ANCOVA analyses were used, with partial squared Eta as the effect size index. RESULTS: Premature LH peak with early follicular rupture occurred in 2 cases in Group 1 (Ant) and 3 cases in Group 2 (DYG), without statistical significance. LH levels on trigger day showed no difference (Ant: 2.63 - SD 1.15 vs. DYG: 2.47 - SD 1.22). Oocyte maturation at metaphase II (MII) stage was similar (6.28 - SD 4.72 vs. 6.71 - SD 4.53). Follicle size differed: fewer follicles ≥ 18 mm in Ant group (3.33 - SD 2.06 vs. 4.19 - SD 2.53; p=0.001), but more 15-17 mm follicles (p=0.024). No moderate to severe OHSS occurred in patients with AMH >3 ng/mL. CONCLUSIONS: DYG is an eligible tool for IVF/ICSI cycles intended to freeze-all and oocyte preservation, embryo banking, and preventing OHSS in patients with high AMH levels.

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