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Fertil Steril. 2020 Jan;113(1):121-130. doi: 10.1016/j.fertnstert.2019.09.012. Epub 2019 Dec 16.

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.

Author information

1
Clinica Valle Giulia, G.EN.E.R.A., Centers for Reproductive Medicine, BioRoma, Rome, Rome, Italy. Electronic address: alberto.vaiarelli@gmail.com.
2
Clinica Valle Giulia, G.EN.E.R.A., Centers for Reproductive Medicine, BioRoma, Rome, Rome, Italy.
3
Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples, Federico II, Naples, Italy.
4
Clinica Valle Giulia, BioRoma, Rome, Italy.
5
Clinica Ruesch, G.EN.E.R.A. Centers for Reproductive Medicine, Naples, Italy.

Abstract

OBJECTIVE:

To assess the clinical contribution of luteal-phase stimulation (LPS) to follicular-phase stimulation (FPS) in a single ovarian cycle (DuoStim) for poor responder patients fulfilling the Bologna criteria.

DESIGN:

Observational study (years 2015-2017) including women satisfying ≥2 of the following characteristics: maternal age ≥40 years and/or ≤3 oocytes retrieved after previous conventional stimulation and/or reduced ovarian reserve (i.e., antral follicle count <7 follicles or antimüllerian hormone <1.1 ng/mL). The LPS was started regardless of the outcome of the FPS.

SETTING:

Private in vitro fertilization center.

PATIENT(S):

A total of 100 of 297 patients fulfilling the Bologna criteria chose to undergo DuoStim.

INTERVENTION(S):

The FPS and LPS with the same antagonist protocol and agonist trigger, intracytoplasmic sperm injection with ejaculated sperm, preimplantation genetic testing for aneuploidies, and vitrified-warmed euploid single blastocyst transfer.

MAIN OUTCOME MEASURE(S):

The contribution of LPS to the cumulative live birth rate (CLBR) per intention-to-treat (ITT).

RESULT(S):

Patients (100) underwent FPS (maternal age, 42.1 ± 1.4 y; previous in vitro fertilization cycles with ≤3 collected oocytes, 0.7 ± 0.9; antral follicle count, 3.8 ± 1.2 follicles; and antimüllerian hormone, 0.56 ± 0.3 ng/mL). Ninety-one patients completed DuoStim. All patients were included in the analysis. More oocytes were obtained after LPS with similar developmental and chromosomal competence as paired FPS-derived ones. The CLBR per ITT increased from 7% after FPS to 15% after DuoStim. Conversely, the CLBR per ITT among the 197 patients that chose a conventional controlled ovarian stimulation strategy was 8%, as only 17 patients who were not pregnant returned for a second stimulation after the first attempt (drop-out rate, 81%).

CONCLUSION(S):

The LPS-derived oocytes increased the CLBR per ITT in a single ovarian cycle in patients fulfilling the Bologna criteria. The DuoStim strategy is promising to manage this thorny population of patients, especially to avoid discontinuation after a first failed attempt.

KEYWORDS:

Bologna criteria; DuoStim; double stimulation; luteal phase stimulation; poor responder

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