Acta Scientific Women's Health (ASWH)(ISSN: 2582-3205)

Research Article Volume 4 Issue 11

A Prospective Comparative Interventional Study of Dydrogesterone (Progestin Primed Ovarian Stimulation) Versus Ganirelix Acetate (GnRh Anatgonist) for Freeze-all IVF/ICSI Cycles

Kedar Ganla1, Rana Choudhary2*, Priyanka Vora2, Seema Pandey3, Jayant Kamat4, Cyriac Pappachan5 and Anil Chittake6

1Consultant, Department of Reproductive Medicine, Ankoor Fertility Clinic, Mumbai, India
2Associate Consultant, Department of Reproductive Medicine, Ankoor Fertility Clinic, Mumbai, India
3Consultant, Department of Reproductive Medicine, Seema IVF, UP, India
4Consultant, Department of Reproductive Medicine, Kamath Fertility clinic, Goa, India
5Consultant, Department of Reproductive Medicine, Life Line Hospital, Kerala, India
6Consultant, Department of Reproductive Medicine, Embrion IVF, Pune, India

*Corresponding Author: Dr Rana Choudhary, Associate Consultant, Department of Reproductive Medicine, Ankoor Fertility Clinic, Mumbai, India.

Received: September 01, 2022; Published: October 12, 2022


Background: With advancement in IVF technology and vitrification, use of progesterone and its derivatives to block the LH surge is increasing. This was a prospective randomized controlled trial, in a private reproductive medicine clinic to compare the efficacy of preventing LH surges by using progesterone primed ovarian stimulation (PPOS) against gonadotropin-releasing hormone (GnRH) antagonist, in women with good ovarian reserve undergoing in vitro fertilization (IVF).

Method/Design: Study participants (n = 220) who met the inclusion criteria were randomized. Both group participants received hMG from day 2. Group 1 (hMG + DYG) received 10mg tablet Dydrogesterone, thrice a day, from day 2 of stimulation. Group 2 (hMG + GAN) received 0.25 mg of Ganirelix acetate, given subcutaneously from fifth day of stimulation till the day of trigger. Main Outcome Measure(s): The primary outcome measured was the incidence of premature LH surges. All embryos were frozen and transferred in the subsequent cycle. Participants were monitored by serial hormonal assays.

Main Outcome Measure(s): The primary point of measurement was the incidence of premature LH surges. We also studied the number of oocytes retrieved, number of embryos formed, implantation and clinical pregnancy rate along with the additional cost per cycle as our secondary end parameters.

Result (s): All subjects in both groups had well controlled LH levels suggesting good control over prevention of premature leutinisation. There was no significant difference in the number (mean ± SD) of oocytes retrieved [P = 0.0691] and viable embryos or the pregnancy rate (PR) after FET 48% {43.64, median (IQR)} versus 39% {(35.45, median (IQR)} (P = 0.215). The additional cost per cycle was significantly high in the antagonist group (p < 0.001).

Conclusion: Our results suggest that Dydrogesterone effectively inhibited spontaneous ovulation, without affecting the number of retrieved oocytes, embryo quality, implantation and pregnancy rates (PR). The cost difference and patient acceptance between both the groups was significant with Dydrogesterone allowing lower costs and easier (oral) administration thus making IVF cycle more patient friendly.

Keywords: LH Surge; Dydrogesterone; Ganirelix Acetate; GnRh Antagonist; PPOS; Freeze All


  1. Cavagna M., et al. “The effect of GnRH analogues for pituitary suppression on ovarian response in repeated ovarian stimulation cycles”. AMS 7 (2011): 470-475.
  2. Kumar P and Sharma A. “Gonadotropin-releasing hormone analogs: Understanding advantages and limitations”. Journal of Human Reproductive Sciences 7 (2014): 170-174.
  3. Tarlatzis BC and Kolibianakis EM. “GnRH agonists vs antagonists”. Best Practice and Research Clinical Obstetrics and Gynaecology 21 (2007): 57-65.
  4. Wang R., et al. “Comparisons of GnRH antagonist protocol versus GnRH agonist long protocol in patients with normal ovarian reserve: a systematic review and meta-analysis”. PLoS One (2017): 12e0175985.
  5. Bosch E., et al. “A. Premature luteinization during gonadotropin-releasing hormone antagonist cycles and its relationship with in vitro fertilization outcome”. Fertility and Sterility 80 (2003): 1444-1449.
  6. Holesh JE and Lord M. “Jun Physiology, Ovulation”. StatPearls. Treasure Island (FL): StatPearls Publishing (2017).
  7. Messinis IE., et al. “Novel aspects of the endocrinology of the menstrual cycle”. Reproductive BioMedicine Online 28 (2014): 714-722.
  8. Stephens SB., et al. “Absent progesterone signaling in kisspeptin neurons disrupts the lh surge and impairs fertility in female mice”. Endocrinology 156 (2015): 3091-3097.
  9. Custodia-Lora N and Callard IP. “Progesterone and progesterone receptors in reptiles”. General and Comparative Endocrinology 127 (2002): 1-7.
  10. Hoff JD., et al. “Hormonal dynamics at midcycle: a reevaluation”. The Journal of Clinical Endocrinology and Metabolism 57 (1983): 792-796.
  11. Liu JH., et al. “Induction of midcycle gonadotropin surge by ovarian steroids in women: a critical evaluation”. The Journal of Clinical Endocrinology and Metabolism 57 (1983): 797-802.
  12. Evans NP., et al. “Neuroendocrine mechanisms underlying the effects of progesterone on the oestradiol-induced GnRH/LH surge”. Reproduction Supplements 59 (2002): 57-66.
  13. Heikinheimo O., et al. “Inhibition of ovulation by progestin analogs (agonists vs antagonists): preliminary evidence for different sites and mechanisms of actions”. Contraception 53 (1996): 55-64.
  14. Chabbert-Buffeta., et al. “Neuroendocrine effects of progesterone”. Steroids 65 (2000): 613-620.
  15. Soules MR., et al. “Progesterone modulation of pulsatile luteinizing hormone secretion in normal women”. The Journal of Clinical Endocrinology and Metabolism 58 (1984): 378-383.
  16. Massin N., et al. “New stimulation regimens: endogenous and exogenous progesterone use to block the LH surge during ovarian stimulation for IVF”. Human Reproduction Update 23 (2017): 211-220.
  17. Dierschke DJ., et al. “Blockade by progesterone of estrogen-induced LH and FSH release in the rhesus monkey”. Endocrinology5 (1973): 1496-1501.
  18. Kasa-Vubu JZ., et al. “Progesterone blocks the estradiol-induced gonadotropin discharge in the ewe by inhibiting the surge of gonadotropin-releasing hormone”. Endocrinology 1 (1992): 208-212.
  19. Richter TA., et al. “Progesterone can block the preovulatory gonadotropinreleasing hormone/luteinising hormone surge in the ewe by a direct inhibitory action on oestradiol-responsive cells within the hypothalamus”. Journal of Neuroendocrinology3 (2005): 161-169.
  20. Kuang Y., et al. “Medroxyprogesterone acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization”. Fertility and Sterility 104 (2015).
  21. Wang Y., et al. “Controlled ovarian stimulation using medroxyprogesterone acetate and hMG in patients with polycystic ovary syndrome treated for IVF: a double-blind randomized crossover clinical trial”. Medicine 95 (2016): e2939.
  22. Zhu X., et al. “Utrogestan as an Effective Oral Alternative for Preventing Premature Luteinizing Hormone Surges in Women Undergoing Controlled Ovarian Hyperstimulation for In Vitro Fertilization”. Medicine (Baltimore) 94 (2015): e909.
  23. Schindler AE., et al. “Classification and pharmacology of progestins”. Maturitas 46 (2008).
  24. Francisca Martinez., et al. “Desogestrel versus antagonist injections for LH suppression in oocyte donation cycles: a crossover study”. Gynecological Endocrinology (2019).
  25. Pelican KM., et al. “Progestin exposure before gonadotropin stimulation improves embryo development after in vitro fertilization in the domestic cat”. Biology of Reproduction 83 (2010): 558-567.
  26. Pelican KM., et al. “Priming with progestin, but not GnRH antagonist, induces a consistent endocrine response to exogenous gonadotropins in induced and spontaneously ovulating cats”. Domestic Animal Endocrinology 34 (2008): 160-175.
  27. Stewart RA., et al. “Oral progestin priming increases ovarian sensitivity to gonadotropin stimulation and improves luteal function in the cat”. Biology of Reproduction 87 (2012): 137.
  28. Yu S., et al. “New application of dydrogesterone as a part of a progestin-primed ovarian stimulation protocol for IVF: a randomized controlled trial including 516 first IVF/ICSI cycles”. Human Reproduction 33 (2018): 229-237.
  29. Salehnia M., et al. “The effects of progesterone on oocyte maturation and embryo development”. International Journal of Fertility and Sterility 7 (2013): 74-81.
  30. Letterie GS. “Inhibition of gonadotropin surge by a brief mid-cycle regimen of ethinyl estradiol and norethindrone: possible role in in vitro fertilization”. Gynecology and Endocrinology 14 (2000): 1-4.
  31. Melo MAB., et al. “The significance of premature luteinization in an oocyte-donation programme”. Human Reproduction 21 (2006): 1503-1507.
  32. Venetis CA., et al. “Progesterone elevation and probability of pregnancy after IVF: a systematic review and meta-analysis of over 60000 cycles”. Human Reproduction Update 19 (2013): 433-457.


Citation: Rana Choudhary., et al. “A Prospective Comparative Interventional Study of Dydrogesterone (Progestin Primed Ovarian Stimulation) Versus Ganirelix Acetate (GnRh Anatgonist) for Freeze-all IVF/ICSI Cycles". Acta Scientific Women's Health 4.11 (2022): 06-18.


Copyright: © 2022 Rana Choudhary., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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