Progestin primed double stimulation versus flexible GnRh antagonist protocol in poor responders. A randomized control study.

Abstract

Abstract Poor ovarian responders represent a daily clinical challenge to fertility practitioners. Dual stimulation protocols aim at maximizing the number of retrieved oocytes in the shortest time. In this study, the progestin primed double stimulation protocol was compared to 2 cycles of the flexible antagonist protocol in poor responders. Additionally, we have investigated both phases of the double stimulation and the effect of the progestin used, Dydrogesterone, on the ovarian response. 90 poor responders, defined according to Bologna criteria, were randomized into 2 groups. Group I, were stimulated using the progestin primed double stimulation protocol and group II, were stimulated by 2 cycles of the flexible antagonist protocol. Total days of controlled ovarian stimulation and the total gonadotropins requirements were comparable among both groups. However, the number of retrieved oocytes were significant higher in the dual stimulation group. There was no statistically significant difference, in the implantation rate, clinical or the ongoing pregnancy rates. In the dual stimulation group, we found that the stimulation days and the gonadotropins requirements were statistically higher in the luteal phase compared to the follicular phase. But we also noticed that luteal stimulation resulted in a significant increase in the number of mature oocytes, fertilization rate and embryos available for cryopreservation. So, we concluded that progestin primed double stimulation is a valuable option in poor ovarian responders. Trial registration number: ClinicalTrials.gov ID: NCT04537078