DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20220742

Dual stimulation protocol for poor responders, promising approach to increase the success rate of in vitro fertilization cycles

Nagwan A. Bahgat

Abstract


Background: It is well known that increasing the number of recruited oocytes affect positively the in vitro fertilization (IVF) cycle outcome. Dual stimulation protocol was invented to increase the number of recruited oocytes in the same cycle through double stimulation and oocyte collection.

Methods: This prospective randomized controlled study was done to compare the outcome of one conventional aspiration-embryo transfer cycle with double stimulation- aspiration then frozen transfer cycle. The results were divided into primary outcomes which included the number of oocytes collected, the maturation rate in both times of oocyte collection and in both groups and while the secondary outcome included the oocytes survival rate, fertilization rate, cleavage rate, available blastocyst, and finally pregnancy rate in both arms of the study.

Results: A total of 180 patients included. In the first group: 203 oocytes were collected with 151 mature oocytes (maturation rate 74%, fertilization rate of 81.5%), 61 good quality embryos and transferred in 27 cycles (49.6% transfer rate) and 4 got pregnant (14.8% pregnancy rate). In the second group: we got 381 oocytes in total through twice oocyte collection, with 289 mature oocytes (75.8% maturation rate). The second group underwent frozen oocytes transfer cycles. All oocytes were thawed: out of 289 frozen oocytes, 156 survived (53.9% survival rate), we obtained 6 pregnancies (26.1%).

Conclusions: Double stimulation protocol followed by double oocytes collection in the same cycle could result in more mature oocytes for patients with poor ovarian reserve who are willing for pregnancy or fertility preservation.


Keywords


Frozen cycles, IVF, Dual stimulation

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References


Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L. ESHRE working group on Poor Ovarian Response Definition ESHRE consensus on the definition of 'poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26:1616-24.

Ferraretti AP, Gianaroli L. The Bologna criteria for the definition of poor ovarian responders: is there a need for revision? Hum Reprod. 2014;29:1842-5.

Younis JS, Ben-Ami M, Ben-Shlomo I. The Bologna criteria for poor ovarian response:-a-contemporary-critical-appraisal. JOvarian. 2015;8:76.

McAvey B, Zapantis A, Jindal SK, Lieman HJ, Polotsky AJ. How many eggs are needed to produce an assisted reproductive technology baby: is more always better? Fertil Steril. 2011;96:332-5.

Duffy JM, Ahmad G, Mohiyiddeen L, Nardo LG, Watson A. Growth hormone for in vitro-fertilization. Cochrane-Database-Syst-Rev. 2010;1:CD000099.

Yeung TW, Chai J, Li RH, Lee VC, Ho PC, Ng EH. A randomized, controlled, pilot trial on the effect of dehydroepiandrosterone on ovarian response markers, ovarian response, and in vitro fertilization outcomes in poor responders. Fertil Steril. 2014;102:108-15.

Fabregues F, Penarrubia J, Creus M, Manau D, Casals G, Carmona F, et al. Transdermal testosterone may improve ovarian response to gonadotrophins in low-responder IVF patients: a randomized, clinical trial. Hum Reprod. 2009;24:349-59.

Polyzos NP, Devroey P. A systematic review of randomized trials for the treatment of poor ovarian responders: is there any light at the end of the tunnel? Fertil Steril. 2011;96:1058-61.

Baerwald AR, Adams GP, Pierson RA. Characterization of ovarian follicular wave dynamicinwomen. Biol Reprod. 2003;69:10231031.

Chen H, Wang Y, Lyu Q, Ai A, Fu Y, Tian H, Cai R, Hong Q, Chen Q, Shoham Z, Kuang Y. Comparison of live-birth defects after luteal-phase ovarian stimulation vs. conventional ovarian stimulation for in vitro fertilization and vitrified embryo transfercycles. Fertil Steril. 2015;103:1194-201.

Zhang J. Luteal phase ovarian stimulation following oocyte retrieval: is it helpful for poor responders? Reprod Biol Endocrinol. 2015;13:76.

Kuang Y, Hong Q, Chen Q, Lyu Q, Ai A, Fu Y, Shoham Z. Luteal-phase ovarian stimulation is feasible for producing competent oocytes in women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment, with optimal pregnancy outcomes in frozen-thawed embryo transfer cycles. Fertil Steril. 2014;101:105-11.

Kuang Y, Chen Q, Hong Q, Lyu Q, Ai A, Fu Y, Shoham Z. Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes (Shanghai-protocol). Reprod Biomed Online. 2014;29:684-91.

Tsampras N, Gould D, Fitzgerald CT. Double ovarian stimulation (DuoStim) protocol for fertility preservation in female oncology patients. Hum Fertil (Camb). 2017;20:248-

Zhang W, Wang M, Wang S, Bao H, Qu Q, Zhang N, Hao C. Luteal phase ovarian stimulation for poor ovarian responders. JBRA Assist Reprod. 2018;22(3):193-8.

Keskintepe L, Sher G, Machnicka A, Tortoriello D, Bayrak A, Fisch J, Agca Y. Vitrification of human embryos subjected to blastomere biopsy for pre-implantation genetic screening produces higher survival and pregnancy rates than slow freezing. J Assist Reprod Genet. 2009;26(11-12):629-35.

Cobo A, Diaz C. Clinical application of oocyte vitrification: a systematic review and meta-analysis of randomized controlled trials, Fertil Steril. 2011;96(2):277-85.

Cardoso MCA, Evangelista A, Sartório C, Vaz G, Werneck CLV, Guimarães FM, de Sá PG, Erthal MC. Can ovarian double-stimulation in the same menstrual cycle improve IVF outcomes? JBRA Assist Reprod. 2017;21(3):217-21.