DISCUSSION
vaginal itching, congenital disabilities
PREGNANCY LOSS, ADVERSE EFFECTS, MISCARRIAGE, MVP, GRIESINGER
In this randomized study, oral dydrogesterone (DYD) was comparable with micronized vaginal progesterone (MVP) pessary regarding chemical pregnancy rate, clinical pregnancy rate, ongoing pregnancy rate, and miscarriage rates. Regarding the tolerability profiles, the two agents are comparable, except that the frequency of vaginal itching was significantly higher in the MVP group (p=0.008). Nevertheless, there was no difference in adverse effects between the study groups.In previous studies on LPS, such as Lotus I [We also found the clinical conception frequencies in the DYD group comparable but lower to that of a recent Lotus II study [A recent study of the categorized population in China observed a variation of 9.4% favoring DYD. However, current conception frequencies at the gestation age of 12 weeks of 61.4% and 51.9% for DYD and MVP gel arms, respectively, were observed [Although pregnancy loss incidences were not studied as straight endpoints in the Lotus I and Lotus II trials and the recent Griesinger Despite the similarities in efficacy, we also found no difference concerning the adverse effects, except for the tolerance rate, which was significantly lower in the MVP group on account of vaginal itching. This finding is understandable since the MVP pessary is administered vaginally as described in the study protocol. Despite the non-significant difference in efficacy, we did not see any significant occurrence of adverse effects rate in the two groups. The aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) parameters did not significantly change pre- and post-therapy. After pregnancy support with DYD or MVP, the ongoing conception incidence was higher than the live birth rate documented in a previous study at one of the hospitals [In this study, the protocol requires that the luteal phase support drugs be administered for 14 weeks of gestation. However, the exact prime dose and the timing of the stoppage of the luteal phase support with progestogens during pregnancy have remained unanswered [Although we utilized only fresh embryo transfer during the study, a recent study by Le The cost of the LPS drugs used in this study reveals that DYD is about three times less expensive than the MVP pessary. This difference is significant and may be a key factor in women's choice, as anything that will reduce the cost of IVF, especially in low resource environment, is welcomed. This is important, considering that couples in most low-income settings pay for IVF treatment on an out-of-pocket basis as the treatment is not covered by all available health insurance policies [This study appears to be the first study comparing DYD and MVP pessary for women undergoing IVF-ET in terms of cost analysis. The focus of the analysis regarding the follow-up of participants was the ongoing conception rate, but closer clinical attention could be paid to the live birth rate. The protocol was restricted to pregnancy, tolerance, and miscarriage rates and did not consider live birth rates. We could not assess the live birth rates not only due to the duration of the study but also because some women did not deliver in the hospital as they came from referrals within and outside the country. Live birth rate and congenital disabilities were, therefore, not included in our outcome. Our study was an "open-label" study design as we could not provide any placebo medication for either of the intervention agents. This might have augmented the risk of bias in the outcomes described in the current study. Additional exploration is needed in our environment to investigate the value of the two agents concerning live birth rates. Additionally, we made our cost analysis relatively simple, at least to improve the understanding of our global readership [