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Comparison of fixed and flexible progestin-primed ovarian stimulation protocols to prevent premature luteinization in patients with diminished ovarian reserve

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Flexible progestin-primed ovarian stimulation (PPOS) protocol is demonstrated to be effective in suppressing premature luteinization in few studies. We aimed to compare fixed and flexible PPOS protocols in preventing premature luteinization in patients with diminished ovarian reserve.

Methods

This retrospective cohort study included patients with a diminished ovarian reserve who were administered PPOS protocols for pituitary suppression during ovarian stimulation in a tertiary center in between January 2019 and June 2022. At fixed protocol, 20 mg/day dydrogesterone was started in cycle day two or three along with gonadotropins and continued until trigger day. In contrast, at flexible protocol, 20 mg/day dydrogesterone was commenced when the leading follicle reached 12 mm or serum estradiol (E2) level was > 200 pg/mL.

Results

A total of 125 patients, of whom 83 were administered fixed PPOS protocol and 42 were administered flexible PPOS protocol, were included in the analysis. Both groups had similar baseline characteristics and cycle parameters, including total days of gonadotropin administration and total gonadotropin dose (p > 0.05). Premature luteinization occurred at 7.2% and 11.9% of patients in fixed and flexible PPOS protocols, respectively (p = 0.505). Retrieved oocytes numbers, metaphase II oocyte numbers, and 2PN numbers were also similar (p > 0.05). Clinical pregnancy rates per transfer were 52.5% in fixed and 36.4% in flexible protocols (p = 0.499).

Conclusion

Both fixed and flexible PPOS protocols had statistically similar outcomes in preventing premature luteinization and other cycle parameters. The flexible PPOS protocol seems to be as effective as the fixed PPOS protocol for patients with diminished ovarian reserve; however, further prospective studies should be conducted to validate the results of our research.

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Data availability

Data are available upon request.

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Acknowledgements

This study’s preliminary data were presented as a poster at the 38th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE), Milan, 3–6 July 2022.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Application and Research Hospital, Adana, Turkey

    Gülşen Doğan Durdağ, Pınar Çağlar Aytaç, Didem Alkaş Yağınç, Selçuk Yetkinel, Tayfun Çok & Erhan Şimşek

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  1. Gülşen Doğan Durdağ
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  2. Pınar Çağlar Aytaç
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  3. Didem Alkaş Yağınç
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  6. Erhan Şimşek
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Contributions

GDD, PÇA, and EŞ designed the study, drafted and revised the manuscript. PÇA, EŞ, and TÇ enrolled patients and assigned participants to interventions. GDD, DAY, and SY contributed to data collection. PÇA and GDD were involved in statistical analysis, interpretation of data, and critical discussion. EŞ and TÇ supervised and revised the manuscript.

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Correspondence to Gülşen Doğan Durdağ.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This study was approved by Başkent University Institutional Review Board (Project No. KA22/333).

This study was performed in accordance with Declaration of Helsinki.

Consent to participate

Informed consent to participate the study was obtained from all patients prior to their treatment.

Consent for publication

Informed consent for publication of the data was obtained from all patients prior to their treatment.

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Doğan Durdağ, G., Çağlar Aytaç, P., Alkaş Yağınç, D. et al. Comparison of fixed and flexible progestin-primed ovarian stimulation protocols to prevent premature luteinization in patients with diminished ovarian reserve. Arch Gynecol Obstet 308, 579–586 (2023). https://doi.org/10.1007/s00404-023-07071-z

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