DuoStim cycles potentially boost reproductive outcomes in poor prognosis patients

Abstract

Aim

To evaluate the overall performance and oocyte quality of follicular phase stimulation (FPS) vs. luteal phase stimulation (LPS) among patients undergoing double ovarian stimulation (DuoStim).

Materials and methods

Observational retrospective two-center cohort study including 79 infertile women who underwent a total of 87 DuoStim cycles between January 2017 and May 2019. Besides assessing baseline characteristics in order to determine the patients’ clinical profile, we analyzed the FPS and LPS regarding the total dose of gonadotropin received, the duration of stimulation, the number and maturity of oocytes, fertilization and blastocyst formation rates, and the number of blastocysts obtained.

Results

The patients’ baseline characteristics were compatible with a diminished ovarian reserve and poor reproductive prognosis. While the luteal phase needed longer stimulation (12 days (5–19) vs. 11 (7–16), p < .001) and slightly higher gonadotropin doses (2946 ± 890 IU vs. 2550 ± 970 IU, p < .001), no significant differences were detected in the oocyte maturity, fertilization, and blastocyst formation rates. However, the number of oocytes retrieved (5 (0–16) vs. 4 (0–15), p = .006), mature oocytes (4 (0–15) vs. 3 (0–11), p = .032), and blastocysts obtained (70 vs. 53) were substantially greater after LPS.

Conclusions

The DuoStim strategy in poor prognosis patients increases the number of oocytes and blastocysts available. Moreover, the number of oocytes and blastocysts obtained are higher after LPS when compared to FPS. Thus, it should be considered for selected patients in order to not only improve reproductive outcomes but also shorten the time to pregnancy.

摘要

目标：评估双重刺激方案(DuoStim)患者卵泡期刺激(FPS)与黄体期刺激(LPS)的总体效果和卵母细胞质量。

材料与方法：双中心、观察性、回顾性队列研究, 共纳入79名不孕妇女, 2017年1月至2019年5月期间共进行了87个DuoStim周期。除了基线评估以确定患者的临床特征之外, 我们分析了FPS和LPS的促性腺激素的总剂量、刺激持续时间、卵母细胞的数量和成熟度、受精率和囊胚形成率以及获得的囊胚数量。

结果：患者的基线特征与卵巢储备减退和生殖预后不良相符合。黄体期需要更长的刺激时间 (12天(5-19) vs.11天(7-16), p<0.001)和稍高的促性腺激素剂量(2946±890IU vs.2550±970IU, p<0.001), 但卵母细胞成熟率、受精率和囊胚形成率没有显著差异。然而, LPS后获得的卵母细胞数量(5(0-16) vs.4(0-15), p＝.006)、成熟卵母细胞(4(0-15) vs.3(0-11), p＝.032)和获得的囊胚(70 vs.53)显著增加。

结论：在生殖预后不良的患者中, DuoStim方案增加了获卵数和囊胚的数量。此外, 与FPS相比, LPS可获得更多的卵母细胞和囊胚。因此, 为改善生殖结局和缩短怀孕时间, 对于选择的患者, 应该考虑DuoStim方案。

Keywords:

• DuoStim
• luteal phase
• oocyte quality
• blastocyst
• ART

Acknowledgements

The results of this study were presented in part at the XXIII Brazilian Congress of Assisted Reproduction, Curitiba-Brazil, July 31 to August 3, 2019.

Disclosure statement

The authors report no conflicts of interest.