Comparing Dydrogesterone Versus Medroxyprogesterone in Progestin-Primed Ovarian Stimulation (PPOS) for Patients Undergoing In Vitro Fertilization/Intracytoplasmic Sperm Injection: A Systematic Review.

Dydrogesterone (DYG) in the progestin-primed ovarian stimulation (PPOS) protocol is an alternative progestin with weaker pituitary suppression than medroxyprogesterone acetate (MPA) in women with normal ovulation. However, the endocrinological characteristics, oocyte retrieval, and pregnancy outcomes of DYG in PPOS patients undergoing in vitro fertilization (IVF) remain unclear. This systematic review aimed to compare the efficacy of DYG and MPA in PPOS protocols in IVF/intracytoplasmic sperm injection (ICSI) cycles. Studies published between 2018 and 2024 were identified through PubMed and the Cochrane Library. After screening and applying the eligibility criteria, only full-text articles directly comparing DYG and MPA in PPOS protocols for IVF/ICSI were included. A total of three studies involving 1,172 patients were analyzed. Both DYG and MPA effectively suppressed premature luteinizing hormone (LH) surges, with no significant differences in the oocyte yield, fertilization rates, or clinical pregnancy rates. DYG was associated with slightly higher post-trigger follicle-stimulating hormone (FSH) levels and lower LH levels compared to MPA, while both groups showed similar estradiol and progesterone trends. Some studies reported significantly lower gonadotropin requirements in the DYG group. Pregnancy outcomes, including biochemical and clinical pregnancy rates, implantation, and miscarriage, were comparable between groups. These findings indicate that both DYG and MPA are effective and safe for LH surge suppression in PPOS protocols, with DYG potentially offering a more physiologic hormonal profile and reduced gonadotropin use. Further randomized controlled trials are recommended to validate these results.