Drospirenone-Primed Ovarian Stimulation Versus GnRH Antagonist Protocol in Poor Ovarian Responders Undergoing Freeze-All IVF/ICSI (PPOS)

July 29, 2026 updated by: Ahmed Saad

Drospirenone-Primed Ovarian Stimulation (PPOS) Versus Flexible GnRH Antagonist Protocol in Poor Ovarian Responders Undergoing a Freeze-All Strategy: A Pilot Randomized Controlled Trial

Participants will:

  • Take either drospirenone (a daily pill) or the standard daily injection during their ovarian stimulation cycle, alongside their regular fertility hormone injections
  • Undergo egg retrieval, with all resulting embryos frozen (no fresh embryo transfer in this study)
  • Have a frozen embryo transferred in a later cycle
  • Complete two short questionnaires about their treatment experience - once before starting the injections/pills, and once after the stimulation phase ends
  • Be followed to determine if the embryo transfer results in a pregnancy

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Single-center, open-label, 1:1 parallel-group pilot RCT, stratified by POSEIDON group. Superiority framing is not used - this pilot is not powered for hypothesis testing on efficacy outcomes; those are reported descriptively with 95% confidence intervals.

Freeze-all is mandated in both arms by protocol (not patient choice). No patient is offered fresh transfer in either arm, so no patient is excluded for requesting one; this is stated explicitly in the consent process so expectations are set at enrollment.

Both arms use a unified flexible start, triggered by leading follicle diameter reaching 14mm - not a fixed calendar day. Rather than fixing both arms to the same stimulation day (which would not account for individual variability in follicular growth rate, a particular concern in POR), both the antagonist and the drospirenone are initiated on the same physiological trigger: once the leading follicle reaches 14mm, whichever arm the patient is randomized to. This achieves genuine unification across arms (identical starting criterion, applied identically) while remaining individualized to each patient's own stimulation pace. This design has direct precedent, as described in Section 2, and retrospective evidence in POR specifically favors flexible-start over fixed-day dosing on oocyte and fertilization outcomes without increased LH-surge risk.

Study Type

Interventional

Enrollment (Estimated)

100

Phase

  • Phase 2
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Egypt
    • Qalyubia Governorate
      • Banhā, Qalyubia Governorate, Egypt, 13512

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Spontaneous menstrual cycles (21-35 days)
  • Poor ovarian response per Bologna criteria (≥2 of 3): advanced age ≥40 or risk factor for POR; previous poor response (≤3 oocytes with conventional stimulation); abnormal ovarian reserve (AFC <7 or AMH <1.1 ng/mL)
  • POSEIDON group recorded at enrollment (1-4) for stratified randomization and pre-specified subgroup description - corrects a known limitation of Bologna-only classification, which pools biologically distinct POR phenotypes
  • Indication for IVF/ICSI
  • Willing and able to undergo mandatory freeze-all/FET protocol
  • Signed informed consent, including explicit acknowledgment that fresh transfer is not offered in either study arm

Exclusion Criteria:

  • Contraindication to ovarian stimulation
  • Known müllerian anomaly
  • Uncontrolled systemic disease
  • 5 prior failed IVF attempts
  • Known contraindication to drospirenone (per product labeling, e.g., renal impairment, adrenal insufficiency, conditions predisposing to hyperkalemia)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Drospirenone
50 cases will receive drospirenone in the form of 1 tablet / d when the leading follicle reaches 14 mm till hCG trigger day
Drug: Drospirenone drug
A drug drospirenone in the form of 1 tablet / d from 14 mm follicle till hCG trigger day
Active Comparator: cetrorelix
50 cases will receive cetrorelix when the leading follicle reaches 14 mm till hCG trigger day
Drug: Cetrorelix 0.25 mg
Cetrorelix a drug injection daily sc. from 14 mm follicle till hCG trigger day

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Metaphase II (Mii) oocytes
Time Frame: Day 0
Number of mature (MII) oocytes retrieved between drospirenone-PPOS and GnRH antagonist protocols, both using a unified flexible start (leading follicle 14mm), in POR patients undergoing a mandatory freeze-all strategy,
Day 0

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of oocytes retrieved
Time Frame: Day 0
Total numbers
Day 0
Fertilization rate 2 pronuclei (2PN)
Time Frame: on day 1
Fertilization rate (2PN) check
on day 1
Quality of day-3 embryos
Time Frame: on day 3
Quality of day-3 embryos (gradeing)
on day 3
LH measure
Time Frame: on trigger day ( 2 days before day 0)
LH measure to follow premature LH surge (LH >15 mIU/mL on trigger day) and premature LH rise (LH >10 mIU/mL)
on trigger day ( 2 days before day 0)
Patient burden score
Time Frame: Day 0
Patient-reported treatment burden and satisfaction, measured using the validated Controlled Ovarian Stimulation Impact Measure (COSI; four domains - Interference in Daily Life, Injection Burden, Psychological Health, Compliance Worry), administered at day 0. each patient will give a score from 0-4
Day 0
CPR ( clinical pregnancy rate)
Time Frame: At 6 wks of pregnancy
Clinical pregnancy rate per embryo transfer
At 6 wks of pregnancy
Cost per cycle
Time Frame: at day 0
Cost per stimulation cycle (drug cost only) in EGP
at day 0
Number of Day 3 embryos
Time Frame: Day 3
Measure the numbers of day 3 embryos
Day 3

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Ahmed Saad

Investigators

  • Study Director: Ahmed s Saad, phD, Professor of OB & GYN

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

August 1, 2026

Primary Completion (Estimated)

October 1, 2027

Study Completion (Estimated)

November 1, 2027

Study Registration Dates

First Submitted

July 22, 2026

First Submitted That Met QC Criteria

July 29, 2026

First Posted (Actual)

July 30, 2026

Study Record Updates

Last Update Posted (Actual)

July 30, 2026

Last Update Submitted That Met QC Criteria

July 29, 2026

Last Verified

July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Hawaa-11

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

the protocol excel sheet

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • CSR

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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