Can ovarian double-stimulation in the same menstrual cycle improve IVF outcomes?

Abstract

ObjectiveTo evaluate the double-stimulation protocol efficacy over conventional ovarian stimulation in recovering a more adequate number of oocytes and increase the number of embryos to be transferred or to be genetically analyzed.MethodsA retrospective and comparative study with 13 patients who underwent unsuccessful in vitro fertilization (IVF) cycles with a conventional antagonist ovarian stimulation protocol and repeat the attempt with a double stimulation protocol. The following variables were analyzed: number of oocytes collected, mature oocytes collected, fertilization rate, blastocyst rate, biopsied blastocyst rate and euploidy rate.ResultsThe double stimulation protocol had a significant higher number of oocytes collected (p=0.007) and mature oocytes to be injected (p=0.01). There was no statistically significant difference in fertilization (p=0.78) and blastocyst (p=0.59) rates.ConclusionDouble stimulation favors patients who are at risk of incurring several attempts of IVF to achieve pregnancy.

Evaluation of the Second Follicular Wave Phenomenon in Natural Cycle Assisted Reproduction: A Key Option for Poor Responders through Luteal Phase Oocyte Retrieval

“…Further to that, it seems that oocytes retrieved from luteal phase stimulation present with the same maturation and fertilization rate with those of follicular phase stimulation [43,44,45]. This evidence concludes that high quality oocytes may be retrieved following the double stimulation protocol [45,46]. In the same line, follow recently reported results regarding the consensus on LuPOR from the embryology laboratory perspective.…”

“…Regarding the later, it is of interest that they appear to present with the same types of chromosome abnormalities [39]. Conclusively, regarding the DuoStim protocol, various studies evaluated and reported a higher total number of collected oocytes, fertilized oocytes, embryos obtained and, last but not least, euploid embryos [46,49]. Paradoxically, a recent retrospective case-control study, in which double ovarian stimulation was performed in older women, reported more MII and fertilized oocytes, along with the prevalence of better-quality embryos in luteal phase stimulation in comparison to follicular phase stimulation [40].…”

“…Optimal management of time and efficient treatment is crucial for women with AMA, POR or cancer patients due to the gonadotoxic effects of the stimulation. These time sensitive patients of advanced age opt for an infertility treatment as their last resort prior to considering egg donation programs [40,46]. The race of collecting as many oocytes as possible in a restricted time frame may be viewed as the holy grail in POR management.…”

“…In the same line, follow recently reported results regarding the consensus on LuPOR from the embryology laboratory perspective. These include the number yielded and the fertilization rate of the oocytes [45], the ability of the respective zygotes to develop into cleavage stage embryos [47] along with the subsequent blastocyst stage development rate [46], as well as the chromosomal status of the embryos originating from SFW oocytes [39]. These studies report no statistically significant differences between stimulated cycles both in the follicular and luteal phase.…”

Luteal phase ovarian stimulation for poor ovarian responders

“…Attempts to start stimulation at any time in the menstrual cycle (‘random-start’ protocols) rather than in the early follicular phase or after down regulation have been reported ( Ozkaya et al ., 2012 ). Double ovarian stimulation resulted in the retrieval of more oocytes within a short period of time and offered new hope for women with POR ( Kuang et al ., 2014a ; Cardoso et al , 2017 ). In order to explore the efficacy of luteal phase ovarian stimulation in women with POR, this study compared the clinical outcomes of luteal phase ovarian stimulation and follicular phase ovarian stimulation protocols.…”