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

Abstract

Background: Emergence of Luteal Phase Oocyte Retrieval (LuPOR) may revolutionize the practice regarding the time-sensitive nature of poor responders ascertaining a higher number of oocytes, in a shorter amount of time. This may be especially important in view of employing the approach of natural cycles for Poor Responders. We suggest the acronym LuPOR describing the clinical practice of luteal phase oocyte retrieval. The aim of the study is to offer insight regarding the identity of LuPOR, and highlight how this practice may improve management of the special subgroup of poor responders. Materials and Methods: The present retrospective observational clinical study includes the collection and statistical analysis of data from 136 poor responders who underwent follicular oocyte retrieval (FoPOR) and subsequent LuPOR in natural cycles, during their In Vitro Fertilization (IVF) treatment, from the time period of 2015 to 2018. All 136 participants were diagnosed with poor ovarian reserve (POR) according to Bologna criteria. The 272 cycles were categorized as follows: 136 natural cycles with only FoPORs (Control Group) and 136 natural cycles including both FoPORs and LuPORs. Results: Our primary results indicate no statistically significant differences with regards to the mean number of oocytes, the maturation status, and fertilization rate between FoPOR and LuPOR in natural cycles. Secondarily, we demonstrate a statistically significant higher yield of oocytes (2.50 ± 0.78 vs. 1.25 ± 0.53), better oocyte maturity status (1.93 ± 0.69 vs. 0.95 ± 0.59) and higher fertilization rate (1.31 ± 0.87 vs. 0.61 ± 0.60) in natural cycles including both FoPOR and LuPOR, when compared to cycles including only FoPOR. Conclusion: Our study may contribute towards the establishment of an efficient poor responders’ management through the natural cycle approach, paving a novel clinical practice and ascertaining the opportunity to employ oocytes and embryos originating from a luteal phase follicular wave.

The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment

“…A novel clinical practice has emerged by employing ovarian stimulation protocols within the luteal phase, succeeding follicular stimulation and oocyte retrieval in an individual menstrual cycle [ 97 ]. Over the past few years, researchers explored the new strategy of stimulation in the luteal phase both independently and in combination with standard stimulation protocols, introducing to the clinical field what is described as the protocol of double stimulation (DuoStim) [ 98 , 99 , 100 ]. As a result, DuoStim consists of an ordinary follicular phase stimulation (FPS) in combination with luteal phase stimulation (LPS) [ 15 , 101 ].…”

“…This approach has been associated with increased chances of a pregnancy being ensued. Triggering the ovarian reserve to its maximum potential inevitably resulted in a higher oocyte yield, prompting clinicians to investigate and produce innovative stimulation protocols particularly targeting POR patients [ 97 , 98 ]. Experts in the field of IVF acknowledge DuoStim as an efficient strategy for managing POR, showcasing it as an innovative method for retrieving oocytes during the luteal phase [ 98 ].…”

“…Interestingly, it has been proposed that double oocyte retrieval could be performed in natural IVF cycles without employing COS. In 2018, Sfakianoudis et al first suggested the term LuPOR for Luteal Phase Oocyte Retrieval [ 98 ]. The use of LuPOR in natural cycles was introduced, aiming to report on the potential of this approach in benefitting the special subgroup of poor responders [ 98 ].…”

“…In 2018, Sfakianoudis et al first suggested the term LuPOR for Luteal Phase Oocyte Retrieval [ 98 ]. The use of LuPOR in natural cycles was introduced, aiming to report on the potential of this approach in benefitting the special subgroup of poor responders [ 98 ]. The results of this study propose that more embryos could be obtained when performing LuPOR in combination with conventional retrieval during the follicular phase [ 98 ].…”

“…The use of LuPOR in natural cycles was introduced, aiming to report on the potential of this approach in benefitting the special subgroup of poor responders [ 98 ]. The results of this study propose that more embryos could be obtained when performing LuPOR in combination with conventional retrieval during the follicular phase [ 98 ]. It is proposed that the natural cycle LuPOR treatment strategy coupled with accumulating embryos through multiple natural cycles may lead to new era in managing POR patients [ 102 ].…”