The effect of dual stimulation on ploidy rates in patients with poor ovarian response

Authors

Keywords:

Duostim, Poor-responder patients, Double ovarian stimulation, Reduce ovarian reserve

Abstract

Background/Aim: It is difficult to obtain healthy oocytes in poor ovarian response patients with conventional treatment methods. This study aimed to find out which agent is most effective at inducing ovulation in one menstrual cyle. We aimed to examine the effects of follicular and luteal stimulation in patients with poor ovarian response on oocyte count, blastocyst, euploid embryo, and pregnancy rates. Methods: A total of 134 patients were included in this retrospective cohort study, and the rates of ploidy in the embryos obtained by follicular and luteal stimulation were evaluated. All cases were treated with the antagonist protocol beforehand. The research was conducted by examining the data of patients who underwent Dual stimulation (Duostim) between 2015 and 2017 in the IVF Clinic of Acıbadem University Atakent Hospital retrospectively. Results: While ploidy rates in FS and LS were significant in terms of age and AMH values (P<0.05 for all), they did not differ with BMI values (P>0.05 for all). The rate of aneuploid embryo development in follicular phase was 81.8%, while that in luteal phase was 18.2%, and the rates of euploid embryo development in follicular and luteal treatments were 34.6% and 18.2%, respectively. The pregnancy rate with euploid embryos by LPS was significantly higher compared that by FPS (P<0.05). Conclusion: Our study concludes that follicles entering the anovulatory phase in the follicular phase can be saved by LS, so that healthier embryos can be obtained.

Downloads

Download data is not yet available.

References

Polat M, Mumusoglu S, Yarali Ozbek I, Bozdag G, Yarali H. Double or dual stimulation in poor ovarian responders: where do we stand? Ther Adv Reprod Health. 2021;15:1-15. doi: 10.1177/26334941211024172.

Briggs R, Kovacs G, MacLachlan V, Motteram C, Baker HW. Can you ever collect too many oocytes? Hum Reprod. 2015;30(1):81-7. doi: 10.1093/humrep/deu272.

Drakopoulos P, Blockeel C, Stoop D, Camus M, de Vos M, Tournaye H, et al. Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos? Hum Reprod. 2016;31(2):370-6. doi: 10.1093/humrep/dev316.

Devroey P, Polyzos NP, Blockeel C. An OHSS-Free Clinic by segmentation of IVF treatment. Hum Reprod. 2011;26(10):2593-7. doi: 10.1093/humrep/der251.

Evans J, Hannan NJ, Edgell TA, Vollenhoven BJ, Lutjen PJ, Osianlis T, et al. Fresh versus frozen embryo transfer: backing clinical decisions with scientific and clinical evidence. Hum Reprod Update. 2014;20(6):808-21. doi: 10.1093/humupd/dmu027.

Poseidon Group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number), Alviggi C, Andersen CY, Buehler K, Conforti A, De Placido G, et al. A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarian response to a low prognosis concept. Fertil Steril. 2016;105(6):1452-3. doi: 10.1016/j.fertnstert.2016.02.005.

Dahdouh EM, Balayla J, García-Velasco JA. Comprehensive chromosome screening improves embryo selection: a meta-analysis. Fertil Steril. 2015;104(6):1503-12. doi: 10.1016/j.fertnstert.2015.08.038.

Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2016; 30(6):CD002118. doi: 10.1002/14651858.CD002118.

Labarta E. DuoStim: a new strategy proposed for women with poor ovarian response. Fertil Steril. 2020; 113:76–7.

Massin N. New stimulation regimens: endogenous and exogenous progesterone use to block the LH surge during ovarian stimulation for IVF. Hum Reprod Update. 2017; 23:211–20.

Cobo A, Garrido N, Crespo J, Jose R, Pellicer A. Accumulation of oocytes: a new strategy for managing low-responder patients. Reprod BioMed Online. 2012; 24:424–32.

Ubaldi FM, Cimadomo D, Vaiarelli A, Fabozzi G, Venturella R, Maggiulli R, et al. Advanced maternal age in IVF: still a challenge? The present and the future of its treatment. Front Endocrinol (Lausanne). 2019; 10:94. doi: 10.3389/fendo.2019.00094

Vaiarelli A, Cimadomo D, Argento C, Ubaldi N, Trabucco E, Drakopoulos P, et al. Double stimulation in the same ovarian cycle (DuoStim) is an intriguing strategy to improve oocyte yield and the number of competent embryos in a short timeframe. Minerva Ginecol. 2019; 71:372–6.

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

Surrey ES, Schoolcraft WB. Evaluating strategies for improving ovarian response_of the poor responder undergoing assisted reproductive techniques. Fertil Steril. 2000; 73: 667–76.

Jin B, Niu Z, Xu B, Chen Q, Zhang A. Comparison of clinical outcomes among dual ovarian stimulation, mild stimulation and luteal phase stimulation protocols in women with poor ovarian response. Gynecol Endocrinol. 2018; 34:694–7.

Alsbjerg B, Haahr T, Elbaek HO, Laursen R, Povlsen BB, Humaidan P. Dual stimulation using corifollitropin alfa in 54 Bologna criteria poor ovarian responders- a case series. Reprod BioMed Online. 2019; 38:677–82.

Bourdon M, Santulli P, Maignien C, Pocate-Cheriet K, Marcellin L, Chen Y, et al. The ovarian response after follicular versus luteal phase stimulation with a double stimulation strategy. Reprod Sci. 2020; 27:204–10.

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

Liu C, Jiang H, Zhang W, Yin H. Double ovarian stimulation during the follicular and luteal phase in women>/=38 years: a retrospective case- control study. Reprod BioMed Online. 2017; 35:678–84.

Rashtian J, Zhang J. Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve. Syst Biol Reprod Med. 2018; 64:216–9.

Ubaldi FM, Capalbo A, Vaiarelli A, Cimadomo D, Colamaria S, Alviggi C, et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle (DuoStim) in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation. Fertil Steril. 2016; 105:1488–95.

Vaiarelli A, Cimadomo D, Trabucco E, Vallefuoco R, Buffo L, Dusi L, et al. Double stimulation in the same ovarian cycle (DuoStim) to maximize the number of oocytes retrieved from poor prognosis patients: a multicenter experience and SWOT analysis. Front Endocrinol (Lausanne). 2018; 9:317.

Vaiarelli A, Cimadomo D, Conforti A, Schimberni M, Giuliani M, D'Alessandro P, et al. Luteal phase after conventional stimulation in the same ovarian cycle might improve the management of poor responder patients fulfilling the Bologna criteria: a case series. Fertil Steril. 2020;113(1):121-30. doi: 10.1016/j.fertnstert.2019.09.012.

Vaiarelli A, Cimadomo D, Petriglia C, Conforti A, Alviggi C, Ubaldi N, et al. 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. Ups J Med Sci. 2020;125(2):121-30. doi: 10.1080/03009734.2020.1734694.

Baerwald AR, Adams GP, Pierson RA. Ovarian antral folliculogenesis during the human menstrual cycle: a review. Hum Reprod Update. 2012;18(1):73-91. doi: 10.1093/humupd/dmr039.: 22068695.

Vaiarelli A, Venturella R, Vizziello D, Bulletti F, Ubaldi FM. Dual ovarian stimulation and random start in assisted reproductive technologies: from ovarian biology to clinical application. Curr Opin Obstet Gynecol. 2017;29(3):153-9. doi: 10.1097/GCO.0000000000000365.

Drakopoulos P, Errazuriz J, Santos-Ribeiro S, Tournaye H, Vaiarelli A, Pluchino N, et al. Cumulative live birth rates in IVF. Minerva Ginecol. 2019; 71:207–10.

Bosch E, Bulletti C, Copperman AB, Fanchin R, Yarali H, Petta CA, et al. How time to healthy singleton delivery could affect decision-making during infertility treatment: a Delphi consensus. Reprod Biomed Online. 2019; 38:118–30.

Cimadomo D, Vaiarelli A, Colamaria S, Trabucco E, Alviggi C, Venturella R, et al. Luteal phase anovulatory follicles result in the production of competent oocytes: intra-patient paired case-control study comparing follicular versus luteal phase stimulations in the same ovarian cycle. Hum Reprod. 2018;33(8):1442-8. doi: 10.1093/humrep/dey217.

Capalbo A, Wright G, Elliott T, Ubaldi FM, Rienzi L, Nagy ZP. FISH reanalysis of inner cell mass and trophectoderm samples of previously array-CGH screened blastocysts shows high accuracy of diagnosis and no major diagnostic impact of mosaicism at the blastocyst stage. Hum Reprod. 2013;28(8):2298-307. doi: 10.1093/humrep/det245.

Evans J, Hannan NJ, Edgell TA, Vollenhoven BJ, Lutjen PJ, Osianlis T, et al. Fresh versus frozen embryo transfer: backing clinical decisions with scientific and clinical evidence. Hum Reprod Update. 2014;20(6):808-21. doi: 10.1093/humupd/dmu027.

Maheshwari A, Pandey S, Amalraj Raja E, Shetty A, Hamilton M, Bhattacharya S. Is frozen embryo transfer better for mothers and babies? Can cumulative meta-analysis provide a definitive answer? Hum Reprod Update. 2018;24(1):35-58. doi: 10.1093/humupd/dmx031.

Ke H, Chen X, Liu YD, Ye DS, He YX, Chen SL. Cumulative live birth rate after three ovarian stimulation IVF cycles for poor ovarian responders according to the bologna criteria. J Huazhong Univ Sci Technolog Med Sci. 2013;33(3):418-22. doi: 10.1007/s11596-013-1134-7.

Kulkarni G, Mohanty NC, Mohanty IR, Jadhav P, Boricha BG. Survey of reasons for discontinuation from in vitro fertilization treatment among couples attending infertility clinic. J Hum Reprod Sci. 2014;7(4):249-54. doi: 10.4103/0974-1208.147491.

Troude P, Guibert J, Bouyer J, de La Rochebrochard E; DAIFI Group. Medical factors associated with early IVF discontinuation. Reprod Biomed Online. 2014;28(3):321-9. doi: 10.1016/j.rbmo.2013.10.018.

Cimadomo D, Carmelo R, Parrotta EI, Scalise S, Santamaria G, Alviggi E, et al. Similar miRNomic signatures characterize the follicular fluids collected after follicular and luteal phase stimulations in the same ovarian cycle. J Assist Reprod Genet. 2020;37(1):149-58. doi: 10.1007/s10815-019-01607-6.

Chen H, Wang Y, Lyu Q, Ai A, Fu Y, Tian H, et al. Comparison of live-birth defects after luteal-phase ovarian stimulation vs. conventional ovarian stimulation for in vitro fertilization and vitrified embryo transfer cycles. Fertil Steril. 2015;103(5):1194-201.e2. doi: 10.1016/j.fertnstert.2015.02.020.

Luo Y, Sun L, Dong M, Zhang X, Huang L, Zhu X, et al. 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. Reprod Biol Endocrinol. 2020;18(1):102. doi: 10.1186/s12958-020-00655-3.

Yang DZ, Yang W, Li Y, He Z. Progress in understanding human ovarian folliculogenesis and its implications in assisted reproduction. J Assist Reprod Genet. 2013;30(2):213-9. doi: 10.1007/s10815-013-9944-x.

Mochtar MH, Danhof NA, Ayeleke RO, Van der Veen F, van Wely M. Recombinant luteinizing hormone (rLH) and recombinant follicle stimulating hormone (rFSH) for ovarian stimulation in IVF/ICSI cycles. Cochrane Database Syst Rev. 2017;5(5):CD005070. doi: 10.1002/14651858.CD005070.

Balasch J, Fábregues F, Casamitjana R, Peñarrubia J, Vanrell JA. A pharmacokinetic and endocrine comparison of recombinant follicle-stimulating hormone and human menopausal gonadotrophin in polycystic ovary syndrome. Reprod Biomed Online. 2003;6(3):296-301. doi: 10.1016/s1472-6483(10)61848-2.

Alviggi C, Conforti A, Esteves SC, Andersen CY, Bosch E, Bühler K, et al. Recombinant luteinizing hormone supplementation in assisted reproductive technology: a systematic review. Fertil Steril. 2018;109(4):644-64. doi: 10.1016/j.fertnstert.2018.01.003.

Mennini FS, Marcellusi A, Viti R, Bini C, Carosso A, Revelli A, et al. Probabilistic cost-effectiveness analysis of controlled ovarian stimulation with recombinant FSH plus recombinant LH vs. human menopausal gonadotropin for women undergoing IVF. Reprod Biol Endocrinol. 2018;16(1):68. doi: 10.1186/s12958-018-0386-2.

Downloads

Published

2021-11-01

Issue

Section

Research Article

How to Cite

1.
Aygün EG, Karabuk E. The effect of dual stimulation on ploidy rates in patients with poor ovarian response. J Surg Med [Internet]. 2021 Nov. 1 [cited 2022 Dec. 1];5(11):1139-43. Available from: https://jsurgmed.com/article/view/1017639