DuoStim cycles potentially boost reproductive outcomes in poor prognosis patients

Cecchino, Gustavo Nardini; Roque, Matheus; Cerrillo, M.; Filho, Rodrigo da Rosa; Chiamba, Flavia da Silva; Hatty, Juliana Halley; García-Velasco, Juan A.

doi:10.1080/09513590.2020.1822804

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…However, Cecchino et al have reported a comparable number of metaphase II oocytes from both stimulation phases. [17] Ubaldi et al postulated that oocyte maturity and fertilization capability are better after luteal stimulation [13]. In our group of patients, we noticed a signi cant improvement in the fertilization rate after luteal stimulation compared to follicular stimulation.…”

Section: Discussionsupporting

confidence: 55%

See 1 more Smart Citation

Progestin primed double stimulation versus flexible GnRh antagonist protocol in poor responders. A randomized control study.

Hussein

Abdelrahman²,

Elabd³

et al. 2023

Preprint

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Poor ovarian responders represent a daily clinical challenge to fertility practitioners. Dual stimulation protocols aim at maximizing the number of retrieved oocytes in the shortest time. In this study, the progestin primed double stimulation protocol was compared to 2 cycles of the flexible antagonist protocol in poor responders. Additionally, we have investigated both phases of the double stimulation and the effect of the progestin used, Dydrogesterone, on the ovarian response. 90 poor responders, defined according to Bologna criteria, were randomized into 2 groups. Group I, were stimulated using the progestin primed double stimulation protocol and group II, were stimulated by 2 cycles of the flexible antagonist protocol. Total days of controlled ovarian stimulation and the total gonadotropins requirements were comparable among both groups. However, the number of retrieved oocytes were significant higher in the dual stimulation group. There was no statistically significant difference, in the implantation rate, clinical or the ongoing pregnancy rates. In the dual stimulation group, we found that the stimulation days and the gonadotropins requirements were statistically higher in the luteal phase compared to the follicular phase. But we also noticed that luteal stimulation resulted in a significant increase in the number of mature oocytes, fertilization rate and embryos available for cryopreservation. So, we concluded that progestin primed double stimulation is a valuable option in poor ovarian responders. Trial registration number: ClinicalTrials.gov ID: NCT04537078

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Section: Discussionsupporting

confidence: 55%

“…Additionally, Cecchino et al, had the same ndings regarding the days of stimulation and the dosage of gonadotropins. [17].…”

Section: Discussionmentioning

confidence: 99%

Progestin primed double stimulation versus flexible GnRh antagonist protocol in poor responders. A randomized control study.

Hussein

Abdelrahman²,

Elabd³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Over time, several independent groups outlined the consistency and reproducibility of double stimulation in terms of safety and efficiency, thus confirming the evidence initially reported by the Chinese and Italian research articles, albeit these conclusions are not supported by RCTs [28–30]. Several observation studies have shown that double stimulation is an effective treatment in patients requiring a large number of oocytes in order to improve the cumulative chance per ovarian cycle [22,30–33].…”

Section: Double Stimulation In the Same Ovarian Cycles: Where Are We?mentioning

confidence: 80%

Double stimulation for the management of poor-prognosis patients: where are we going?

Petrone

Vaiarelli

Blockeel

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewThe technical improvements in IVF allowed the implementation of nonconventional ovarian stimulation protocols for some specific patients. Where time is crucial, such as with oncologic patients, poor-prognosis patients, patients with low ovarian reserve, and those with advanced maternal age, access to IVF treatment is even more critical. Some of these protocols might start in the late follicular phase, luteal phase, or involve both stimulations within the same ovarian cycle.Recent findingsUntil now, published evidence showed that oocytes retrieved from unconventional protocol seem to be developmentally, genetically, and reproductively competent. Second stimulation in the same ovarian cycle after the conventional approach may represent a sound alternative to oocyte accumulation. This can be proposed in progress after careful counselling focused on the patients’ chances of finding at least one euploid embryo on account of their age and of the number of blastocysts obtained after the conventional approach.SummaryThe adoption of these new strategies, known as double stimulation protocol, can be conceived as a real full-personalization of ovarian stimulation. Multicentre prospective RCTs are urgently needed to evaluate the efficacy, efficiency, and costs of double stimulation versus two consecutive conventional approaches with standard or mild stimulation and in a different IVF setting.

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“…From a literature review, 34 studies were published regarding the double stimulation approach in patients undergoing IVF treatment (Table 1). Among them, 23 studies used GnRH agonist trigger for final oocyte maturation in the first stimulation [3,4,5 ▪ ,7,8,10,11,14–23,24 ▪ ,25–29], six studies used hCG (3 rec-hCG and 2 u-hCG) [30–35], and five studies did not specifically distinguish the type of the trigger (GnRH-a ± hCG or hCG) [13,36–39]. GnRH agonist is the most common agent used for triggering and this tendency might depend on the putative negative effect exerted by the longer half-life of hCG on follicle growth during the subsequent LPS [18].…”

Section: Body Of Evidence Regarding Different Trigger Strategies In M...mentioning

confidence: 99%

GnRH agonist trigger in poor prognosis patients undergoing a multicycle approach through DuoStim or consecutive stimulations: a SWOT analysis

Vaiarelli,

Ruffa,

Cerrillo

et al. 2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Identify the most recent and significant evidence regarding the ovulation trigger within the framework of a multicycle approach through DuoStim, providing valuable insights for improving treatment strategies in patients with a poor prognosis. Recent findings The trigger method plays a pivotal role in optimizing in-vitro fertilization (IVF) stimulation, influencing oocyte retrieval and maturation rates, as well as follicle recruitment in consecutive ovarian stimulations such as double stimulation. Decision-making involves multiple factors and, while guidelines exist for conventional stimulation, specific recommendations for the multicycle approach are not well established. Summary The different methods for inducing oocyte maturation underscore the need for personalization of IVF protocols. The GnRH agonist trigger induces rapid luteolysis and establishes favorable hormonal conditions that do not adversely affect the recruitment of consecutive follicular waves in the context of DuoStim. It serves as a valid alternative to hCG in freeze-all cycles. This strategy might enhance the safety and flexibility of ovarian stimulations with no impact on oocyte competence and IVF efficacy.

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DuoStim cycles potentially boost reproductive outcomes in poor prognosis patients

Cited by 8 publications

References 24 publications

Progestin primed double stimulation versus flexible GnRh antagonist protocol in poor responders. A randomized control study.

Progestin primed double stimulation versus flexible GnRh antagonist protocol in poor responders. A randomized control study.

Double stimulation for the management of poor-prognosis patients: where are we going?

GnRH agonist trigger in poor prognosis patients undergoing a multicycle approach through DuoStim or consecutive stimulations: a SWOT analysis

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