What is the true place of a double stimulation and double oocyte retrieval in the same cycle for patients diagnosed with poor ovarian reserve? A systematic review including a meta-analytical approach

Abstract

Purpose This systematic review including a meta-analytical approach aims to investigate the safety and efficacy of employing a double ovarian stimulation (DuoStim) and a subsequent double oocyte retrieval in the same menstrual cycle, in poor ovarian reserve (POR) patients. Methods A systematic search of literature was performed in the databases of PubMed/MEDLINE, Embase, and Cochrane Central Library up until March 2019. Both prospective and retrospective cohort studies considered suitable for inclusion reported on women with POR undergoing a DuoStim in the follicular (FPS) and luteal phase (LPS) of the same menstrual cycle. Following the systematic review of the literature, a meta-analytical approach was attempted. Results This study indicates that DuoStim is correlated with a higher number of retrieved oocytes, mature MII oocytes, and goodquality embryos in comparison to conventional stimulation. Additionally, LPS seems to be correlated with an equal or an even higher overall performance in comparison to FPS. Conclusion DuoStim favors an enhanced clinical outcome in regard to the total number of yielded oocytes, mature oocytes, and available embryos, along with the quality of obtained embryos. Sourced data indicate that LPS is not correlated with a higher aneuploidy rate. This option may present as promising for the time-sensitive nature of POR patients' management, by enabling a higher oocyte yield during a single menstrual cycle.

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

“…Baerwald et al has proposed three theories of follicle recruitment [28] : the theory of continuous recruitment, single recruitment theory, and the wave theory. The theory of continuous recruitment includes the interval between two ovulations [47]. During this time, the follicles begin to grow continuously and gradually disappear, and the dominant follicle is randomly selected after the corpus luteum has degenerated.…”

The Conundrum of Poor Ovarian Response: From Diagnosis to Treatment

“…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.…”

“…Data presented in the study of Kuang et al indicate that COS conducted in both FPS and LPS could enhance oocyte yield and subsequently the number of generated embryos, improving the IVF success rate [ 97 ]. Since then, several studies were conducted investigating the effectiveness of different DuoStim protocols employing different COS strategies [ 15 , 99 , 101 ]. A systematic review and meta-analysis, published by Sfakianoudis and colleagues, demonstrated that DuoStim approaches could effectively increase oocyte yield in the same menstrual cycle, and this is a significant outcome considering the time-sensitive nature of POR patients [ 15 ].…”

“…A plethora of strategies and stimulation protocols have been proposed in the current literature [ 13 ]. In the last few decades, a variety of different gonadotropins stimulation protocols, adjuvant therapies and protocols employing a second oocyte retrieval in an individual menstrual cycle have been proposed in an effort to increase the oocyte yield of POR patients [ 3 , 14 , 15 ]. Choosing the most suitable protocol or treatment strategy for these patients may provide them with a solution addressing a highly time-sensitive matter.…”

Nova dosagem de testosterona transdérmica em gel previamente à estimulação ovariana controlada em pacientes potencialmente más respondedoras: resultados preliminares

“…Evidenciamos que a utilização de testosterona transdérmica na dose de 25mg a cada 48h, maior do que as doses utilizadas em outros estudos em pacientes potencialmente más respondedoras (MASSIN et al, 2006;BALASCH et al, 2006;SIPE et al, 2010;FABREGUES et al, 2009;HOWLES;LEE, 2011;KIM et al, 2014;BOSDOU et al, 2016;DOAN et al, 2017) MASSIN et al, 2006, SIPE et al, 2009e BOSDOU et al, 2016 (BALASCH et al, 2006;FABREGUES et al, 2009;HOWLES;LEE, 2011e KIM et al, 2014 (SFAKIANOUDIS et al, 2019). No nosso estudo, a medida de tamanho de efeito de Cohen (COHEN et al, 1988)…”