Is it effective for patients taking dienogest to use progestin-primed ovarian stimulation (PPOS) protocol during controlled ovarian hyperstimulation (COH), compared to PPOS with dydrogesterone (DYG)?
Patients taking dienogest can continue the endometriosis treatment and get good quality embryo using PPOS during COH, despite they have severe ovarian endometriosis.
What is known already
Dienogest is an oral progestin effective for the treatment of symptomatic endometriosis, such as reduction of endometrial lesion and control of pain intensity with safe profile and good tolerability. Dienogest also provides complete ovulation inhibition at a daily dose of 2mg, and a rapid recovery of ovarian function after cessation of its administration. PPOS is a new COH regimen using a progestin as alternative to GnRH antagonist for blocking LH surge, and several reports have shown that DYG is an appropriate progestin for PPOS protocol. However, dienogest has not been used in PPOS protocol yet.
Study design, size, duration
This was a prospective controlled study of 145 women with endometriosis (aged <41) undergoing COH for IVF/ICSI and frozen embryo transfer (FET) at our infertility center from February in 2018 to November in 2019. The patients taking dienogest were allocated in Study group, and the other patients taking PPOS with DYG were allocated in Control group.
Participants/ Materials, setting, methods
A total of 145 patients were analyzed, PPOS with DNG: 71 patients, PPOS with DYG: 74 patients. Of the participants, 111 patients were histologically confirmed as endometriosis and 39 patients were diagnosed with published imaging criteria using transvaginal ultrasonography, respectively. Patients took DNG 2mg continuously in DNG group, and DYG were started day 3 of COH cycle. Patients were administrated with 150-225 IU of human menopausal gonadotropin (hMG) daily for COH. All viable embryos were cryopreserved for later transfer. The primary outcome measure was the clinical pregnancy rate.
The number of oocytes retrieved in DNG group was less than that of DYG group (6.18±3.60 vs. 9.85±5.77, P<0.001), however, the rate of mature oocytes in DNG group was significantly higher than in DYG group [89.1% (391/439) vs. 78.9% (575/729), P<0.001].The fertilization rate was comparable between the two groups (C-IVF; 69.0% for DNG group vs. 65.1% for DYG group, P=0.510, ICSI; 80.1% for DNG protocol vs. 78.2% for DYG group, P=0.558). The clinical pregnancy rate [Odds ratio (OR) 1.15, 95%CI: 0.69～1.94, P=0.579 ] :50.5% (54/107) for DNG group vs.46.8% (59/126) for DYG group. The ongoing pregnancy rate [OR 0.70, 95%CI: 0.45～1.61, P=0.323]:55.2% (37/67) for DNG group vs.63.6% (42/66) for DYG group did not differ between the two groups.
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