Double ovarian stimulation during the follicular and luteal phase in women ≥38 years: a retrospective case-control study

Abstract

Previous studies have shown that double ovarian stimulation could obtain more oocytes in women with poor ovarian response. This retrospective case-control study aimed to investigate the efficacy of double ovarian stimulation in older women. One hundred and sixteen women aged ≥38 years who received double ovarian stimulation were assigned to the study, with 103 divided into four groups according to follicular-phase ovarian stimulation protocols, including gonadotrophin-releasing hormone agonist short protocol (n = 27), gonadotrophin-releasing hormone antagonist protocol (n = 32), mild stimulation protocol (n = 21) and medrocyprogesterone acetate (MPA) pituitary down-regulation protocol (n = 23). Numbers of oocytes retrieved and available embryos after double ovarian stimulation were more than double those obtained after follicular-phase ovarian stimulation alone. In total 81.90% of patients had available embryos, and the cancellation rate decreased from 37.07% to 18.10%. Forty-eight cases underwent 50 cryopreserved embryo transfer cycles, with a 22.00% clinical pregnancy rate. The implantation rate (10.53% versus 10.67%) was similar between the embryos derived from first and second stimulations. The results suggest that double ovarian stimulation could increase the chances of achieving pregnancy by accumulating more oocytes/embryos in a short time, which might serve as a useful strategy for older women.

Luteal phase anovulatory follicles result in the production of competent oocytes: intra-patient paired case-control study comparing follicular versus luteal phase stimulations in the same ovarian cycle

“…A significantly higher number of oocytes collected after LPS than after FPS has already been reported from previous studies ( Kuang et al , 2014 ; Liu et al , 2017 ). The higher number may have been influenced by the DuoStim approach itself, since LPS is conducted soon after FPS is ended.…”

The best execution of the DuoStim strategy (double stimulation in the follicular and luteal phase of the same ovarian cycle) in patients who are poor ovarian responders

“…There is currently limited research on DuoStim for POR [7][8][9][10][11][12][13][14][15][16]. This may be due to the fact that the traditional COS protocol is preferred in more clinical practices, as DuoStim is time-consuming and costly.…”

Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve

“…Thus, within a single menstrual cycle, there can theoretically be multiple opportunities for a clinician to collect oocytes, as opposed to the conventional single cohort of antral follicles during the follicular phase (Vanden Brink et al 2013). Utilizing this concept, reproductive endocrinologists have been attempting to retrieve oocytes from poor responders using both the follicular-phase stimulation (FPS) and the luteal-phase stimulation (LPS) protocols in order to increase the number of oocytes collected in shorter period of time (Kuang et al 2014a;Zhang 2015;Liu et al 2017;Zhang et al 2017). The number of oocytes collected in IVF is a robust surrogate outcome for clinical success since there is a clear relationship between the number of oocytes collected and live birth rates across all female age groups (Sunkara et al 2011).…”