DuoStim – a reproducible strategy to obtain more oocytes and competent embryos in a short time-frame aimed at fertility preservation and IVF purposes. A systematic review

Abstract

Recent evidence suggests that follicular development occurs in a wave-like model during the ovarian cycle, where up to three cohorts of follicles are recruited to complete folliculogenesis. This understanding overtakes the previous dogma stating that follicles grow only during the follicular phase of the menstrual cycle. Therefore, in in vitro fertilization (IVF), novel protocols regarding ovarian stimulation have been theorized based on the use of gonadotrophins to prompt the growth of antral follicles at any stage of the menstrual cycle. These unconventional protocols for ovarian stimulation aim at a more efficient management of poor-prognosis patients, otherwise exposed to conflicting outcomes after conventional approaches. DuoStim appears among these unconventional stimulation protocols as one of the most promising. It combines two consecutive stimulations in the follicular and luteal phases of the same ovarian cycle, aimed at increasing the number of oocytes retrieved and embryos produced in the short time-frame. This protocol has been suggested for the treatment of all conditions requiring a maximal and urgent exploitation of the ovarian reserve, such as oncological patients and poor responders at an advanced maternal age. At present, data from independent studies have outlined the consistency and reproducibility of this approach, which might also reduce the drop-out between consecutive failed IVF cycles in poor-prognosis patients. However, the protocol must be standardized, and more robust studies and cost-benefit analyses are needed to highlight the true clinical pros and cons deriving from DuoStim implementation in IVF.

Keywords:

• Advanced maternal age
• Bologna criteria
• double ovarian stimulation
• fertility preservation
• DuoStim
• PGT
• poor-prognosis patients
• poor-responder patients
• reduced ovarian reserve

Disclosure statement

AV, FMU, LR, and CA report personal fees and honoraria outside the submitted work. DC, SF, AC, SL, NU, and CP have nothing to disclose.

Additional information

Notes on contributors

Alberto Vaiarelli

Alberto Vaiarelli, MD, PhD, is a Specialist in Obstetrics and Gynaecology and has a Master degree in Reproductive Medicine, Andrology, and IVF. He works at the G.EN.E.R.A. Centre for Reproductive Medicine of Rome.

Danilo Cimadomo

Danilo Cimadomo, PhD, is the Scientific Coordinator of the G.EN.E.R.A. Centres for Reproductive Medicine.

Cecilia Petriglia

Cecilia Petriglia, MD, is a resident in Obstetrics and Gynaecology at the University of Cagliari, Policlinico Universitario Duilio Casula of Monserrato.

Alessandro Conforti

Alessandro Conforti, MD, PhD, is a Specialist in Obstetrics and Gynaecology at the Department of Neuroscience, Reproductive Science and Odontostomatology, University Federico II of Naples.

Carlo Alviggi

Carlo Alviggi, MD, PhD, is Associate Professor in Obstetrics and Gynaecology at the Department of Neuroscience, Reproductive Science and Odontostomatology, University Federico II of Naples.

Nicolò Ubaldi

Nicolò Ubaldi is a Medical Student of the Catholic University of the Sacred Heart of Rome.

Sergio Ledda

Sergio Ledda, PhD, is Professor in Veterinary Medicine at the University of Sassari.

Susanna Ferrero

Susanna Ferrero, MD, is a Specialist in Obstetrics and Gynaecology. She works at the G.EN.E.R.A. Centre for Reproductive Medicine of Rome.

Laura Rienzi

Laura Rienzi, MSc, is the Laboratory Director of the G.EN.E.R.A. Centres for Reproductive Medicine.

Filippo Maria Ubaldi

Filippo Maria Ubaldi, MD, PhD, is the Clinical Director of the G.EN.E.R.A. Centres for Reproductive Medicine.