Double ovarian stimulation (DuoStim) protocol for fertility preservation in female oncology patients

Abstract

This article describes a revised ovarian stimulation protocol (DuoStim) for fertility preservation in female oncology patients which aims to maximise the number of gametes obtained with subsequent improvement in cumulative birth rate, without delaying cancer treatment. Ten patients diagnosed with malignancy between September 2014 and October 2015 were included. The patients were treated with the DuoStim protocol, undergoing two consecutive ovarian stimulation cycles and two oocyte retrievals. The primary outcome was the number of oocytes collected and vitrified during each oocyte retrieval and in total. The protocol was evaluated regarding medical risk and patients' feedback. During the first oocyte collection 81 oocytes (61 metaphase II) were retrieved (mean = 8.1; range = 1-13) and during the second oocyte collection 82 oocytes (67 metaphase II) were retrieved (mean= 8.2; range = 1-19). A total of 163 oocytes (128 metaphase II) were collected (mean = 16.3; range = 6-32) and cancer treatment was not delayed for any of these patients. There were no cases of ovarian hyperstimulation syndrome recorded. More patients and long-term follow-up is needed to assess the efficacy and safety of the DuoStim protocol. However, these early results are encouraging, demonstrating an increase in number of mature oocytes retrieved during ovarian stimulation for oncology patients, without delaying cancer treatment.

DuoStim – a reproducible strategy to obtain more oocytes and competent embryos in a short time-frame aimed at fertility preservation and IVF purposes. A systematic review

“…However, in many patients, there are not enough oocytes collected to ensure reasonably good chances of pregnancy. Based on this, when the time is limited and the oocytes collected from one stimulation are insufficient, DuoStim protocols might be discussed with the oncologist together with the patients as a valuable option for fertility preservation (23)(24)(25)(26).…”

“…A further pilot study published in 2017 by Tsampras et al (23) tested the efficacy of double stimulation for fertility preservation in oncological patients. Ten patients underwent double stimulation with GnRH antagonist and HMG protocol.…”

Fertility Challenges and Solutions in Women with Cancer

“…Based on the concept of multiple follicular waves, a second cycle can be proposed following the first one, offering the possibility of accumulating vitrified oocytes (36). Double ovarian stimulation (DuoStim) has been performed with success in cancer patients, leading to the vitrification of around 16 oocytes per patient (range: 6-32; n=10) (37).…”

“…The impact of the disease on the ovarian response remains controversial. Several studies have not shown any difference in the number of oocytes collected between oncological and nononcological patients or according to disease type (26,(37)(38)(39)(40). Others have reported lower fertility preservation performance in patients with breast cancer (29) and BRCA-mutated breast cancer (41), lymphoma (42) and ovarian cancer (39).…”

Breast cancer and ovulation induction

“…If a suitable follicular development wave is achieved thanks to this process, random ovulation induction forms can be implemented as a late follicular and luteal ovulation induction in the same cycle except for the classical ovulation induction. Depending on the same principle, more than one ovulation induction in both follicular and luteal phases can be carried out in the same cycle [31,32].…”