In poor ovarian responders, does the progestin used in progestin primed dual stimulation have a negative effect on the ovarian response? A randomized clinical trial

  • Aly Ahmed Hussein Department of Obstetrics and Gynecology Faculty of Medicine, Alexandria University, Egypt.
  • Ashraf Hany Abdelrahman
  • Mohamed Mourad Elabd
  • Sherif Salah Gaafar
Keywords: progestin primed; poor responders; dual stimulation; flexible; dydrogesterone; Egypt


Background: Poor ovarian responders involve 9–24% of patients undergoing IVF. the management of those patients is an everyday practice challenge. The dual stimulation protocol is an effective way to increase the number of oocytes and embryos obtained over a relative short period of time. Furthermore, there is increasing evidence that progestins can be a reliable method of preventing the premature LH surge during ovarian stimulation.

Objective: In this study we investigated the effect of the progestin used, Dydrogesterone, in the progestin primed dual stimulation protocol in poor ovarian responders on the ovarian response.

Methods: 90 infertile women indicated for ICSI with criteria of poor ovarian response defined by Bologna criteria were randomized in a prospective manner in Madina infertility center in Alexandria starting from 2020 till 2021.These were further subdivided based on computer randomization into 2 groups. Group I (Dual stimulation group) including 45 patients were given the progestin primed double stimulation protocol and Group II (Flexible antagonist group) including 45 patients were given the flexible GnRh antagonist protocol in 2 cycles.

Results: the M2 number and the fertilization rates showed no statistical significance between both groups in the age groups younger or older than 35 years. Additionally, the resultant embryo number showed no statistically significant difference as well.

Conclusion: the progestin used in progestin primed dual stimulation had no negative impact on the ovarian response in poor ovarian responders.