Dydrogesterone (DYG) in the progestin-primed ovarian stimulation (PPOS) protocol is an alternative progestin with weaker pituitary suppression than medroxyprogesterone acetate (MPA) in women with normal ovulation. However, the endocrinological characteristics, oocyte retrieval, and pregnancy outcomes of DYG in PPOS patients undergoing in vitro fertilization (IVF) remain unclear. This systematic review aimed to compare the efficacy of DYG and MPA in PPOS protocols in IVF/intracytoplasmic sperm injection (ICSI) cycles. Studies published between 2018 and 2024 were identified through PubMed and the Cochrane Library. After screening and applying the eligibility criteria, only full-text articles directly comparing DYG and MPA in PPOS protocols for IVF/ICSI were included. A total of three studies involving 1,172 patients were analyzed. Both DYG and MPA effectively suppressed premature luteinizing hormone …