Impact of Pretreatment with Dydrogesterone versus Estradiol Valerate Combined with Dydrogesterone on ICSI success in women with Polycystic Ovary Syndrome: A Comparative Study

Ali, Ahmed Salah; Abdel Hafez, Mohamed Yahya; Atya, Mostafa; Abd El Ghafar, Hazem; SABRY, MOHAMED

doi:10.21608/smj.2025.395321.1582

Impact of Pretreatment with Dydrogesterone versus Estradiol Valerate Combined with Dydrogesterone on ICSI success in women with Polycystic Ovary Syndrome: A Comparative Study

Document Type : Original Article

Authors

¹ obstetrics and genecology department faculty of medicine- sohag university - sohag - Egypt

² obesterics and gynacology faculty of medicine sohag university

³ Obstetriacs and Gynaecology department, faculty of medicine. Sohag University, Egypt

10.21608/smj.2025.395321.1582

Abstract

Background: For women facing infertility because of PCOS who haven’t conceived through timed intercourse or IUI, ART like ICSI offer a path forward. Various ovarian stimulation methods are employed in ICSI, including protocols using GnRH agonists, GnRH antagonists, and POPS . Administering steroids in the cycle before ICSI synchronizes follicle development and schedule the treatment start for women with PCOS. This research investigates how pretreatment with dydrogesterone alone compares to a combination of estradiol valerate and dydrogesterone in terms of embryological outcomes and pregnancy rates following ICSI in females with PCOS.

Results: We noticed no statistically significant differences between the group pretreated with dydrogesterone only and the group receiving combined estradiol valerate and dydrogesterone. Conception rates were similar (49.05% vs. 59.15%, P=0.4), as were clinical pregnancy rates (41.5% vs. 51.05%, P=0.4) and implantation rates (27.12% vs. 32.71%, P=0.65). While the combined estrogen-progesterone pretreatment showed a improved ICSI outcomes in PCOS patients, the pregnancy rate difference compared to dydrogesterone-only pretreatment wasn’t statistically significant. No OHSS happened in both groups.

Conclusions: Pretreatment before ICSI, using either dydrogesterone alone or a combination of estradiol valerate and dydrogesterone, helps schedule cycles, synchronize follicle growth, yield a high number of mature oocytes, enhance conception, implantation, and clinical pregnancy rates, and prevent OHSS in females with PCOS. Compared to dydrogesterone alone, the combined pretreatment protocol reduced the required gonadotrophin dosage, thereby lessening the cost for patients, and yielding more oocytes. The combined approach improved ICSI outcomes in PCOS patients while reducing the rate of multiple pregnancies.

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