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

IF 1.8 Q3 OBSTETRICS & GYNECOLOGY Jornal Brasileiro de Reproducao Assistida Pub Date : 2025-03-13 DOI:10.5935/1518-0557.20250003

Marcelo Marinho de Souza, Maria do Carmo Borges de Souza, Roberto de Azevedo Antunes, Ana Luíza Barbeitas, Verônica de Almeida Raupp, Ana Luísa Bruno Marinho de Souza, Layna Almeida Barbosa da Silva, Ana Cristina Allemand Mancebo, Flávia Fernandes Sequeira

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Abstract

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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