Double stimulation in a single menstrual cycle increases the number of oocytes retrieved in poor prognosis patients undergoing IVF treatment. Prospective study with historical control
F.M. Ubaldi, A. Vaiarelli, C. Alviggi, E. Trabucco, F. Zullo, A. Capalbo, D. Cimadomo, L. Rienzi
Fertility and Sterility, Volume 104, Issue 3, Supplement, September 2015, Pages e322
71st Annual Meeting of the American Society for Reproductive Medicine
The antral follicle development in human ovary seems to be characterized by 2-3 waves during an interovulatory interim. This evidence overtakes the common concept that a single cohort of antral follicles grows in the follicular phase. Accordingly, a new model for controlled ovarian stimulation (COS) has been proposed: a double COS starting first in the early follicular and secondly in the early luteal phase of a single menstrual cycle (DUOSTIM). The rational of this approach is to increase the number of oocytes available per cycle.
The aim of this prospective study with historical control is to compare standard COS versus DUOSTIM in poor prognosis patients. Inclusion criteria were: < 7 cumulus-oocyte complexes (COCs) retrieved in previous standard cycle, AMH ≤ 1.6 ng/ml and AFC ≤ 7. DUOSTIM was started first on day 2 with administration of gonadotropins in combination with GnRH antagonist. After the first oocyte retrieval, a daily dose of GnRH antagonist was administrated for 3 days before repeating the same protocol. Primary outcome measure is number of COCs retrieved. Secondary outcome measures are number of mature oocytes (MII) and of blastocysts obtained.
Materials and Methods
The time span between the standard COS (control group, n=17) and the DUOSTIM (study group, n=17) was ≤ 6 months. Mature oocytes were inseminated by ICSI and embryos were cultured up to blastocyst stage and cryopreserved. Paired t test and Mc Nemar’s test were used to compare continuous and categorical variables, respectively. Alfa was set at 0.05.
Results are shown in the table. * p <0.01 for comparisons with control group; All other comparisons are not significantly different.
The possibility to take advantage of multiple follicle waves within a single menstrual cycle may open new opportunities in treating patients with reduced ovarian reserve. According to our preliminary results, DUOSTIM increases the number of retrieved oocytes and obtained blastocysts in a determined time frame. This approach may be particularly useful in PGD/PGS cases where freeze-all is however required and I all those patients with a reduced time to conceive.