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Double stimulation (Duo-OPU)

 —  Continuous stimulation and oocyte retrieval during both the follicular and luteal phases of poor responders in IVF/ICSI programs can increase the obtained oocytes per menstrual cycle

Since the patients with diminished ovarian reserve could spend lots of time, energy, and money, on the multiple IVF treatments, the idea of double stimulation in a single cycle was developed. The following study is to compare the IVF outcomes obtained after single-stimulation (follicular phase stimulation) versus duoble stimulation (during both the follicular and luteal phases) in poor responders in IVF/ICSI programs.

Accordingly, it was believed that more than one follicular wave in a single menstrual cycle:

The retrospective study in Stork Fertility Center involved of total 388 oocytes from 79 patients in which the oocyte-donors were excluded during January to December, 2016. The total of 79 poor responders in IVF/ICSI programs (Bologna Criteria) underwent either duo-stimulation (45 cycles) or single-stimulation (156 cycles).

The mild stimulation 
or nature cycle protocols were used in both the groups,

All the embryos were cultured to blastocyst stage. For those need preimplantation genetic screening (PGS), the blastocysts were biopsied in Day 5 or Day 6. The applied method of PGS includes whole genome amplification following with NGS (Miseq®). The resulted copy number variation analysis was performed on BlueFuse Multi software.

According to the results, the obtained mature oocytes (MII oocytes) per cycle were significant higher in duo-stimulation group (mean 2.83) compare to single-stimulation group (mean 1.53) (p=0.001).

Our data also showed that no significant difference were observed between single-Stimulation and duo-Stimulation in MII rate (81.03%; 83.70%), fertilization rate (72.9%; 73.33%), good embryo rate (74.07%; 69.70%), good blastocyst rate (62.50%; 51.52%), and euploid rate (30.77%; 13.0%). (The data for the PGS in due-stimulation group was limited.)

In conclusion, duo-stimulation statistically significantly increasing the obtained oocytes per menstrual cycle compare to single-stimulation and resulted in similar IVF outcome in patients with reduced ovarian response. Our study suggests this novel stimulation strategy will help poor responders to collect more mature oocytes within a single menstrual cycle.

The abstract was released in the 2017, Asia Pacific Initiative on Reproduction annual congress. (2017 ASPIRE)
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