Dual stimulation in unexpected poor responder POSEIDON classification group 1, sub–group 2a: A cross-sectional study

Abstract

<jats:p>Background: Poor ovarian response management is a complex and controversial issue in the field of reproductive medicine.&#x0D; Objective: The aim of this study was to apply double stimulation in the same cycle in unexpected poor responders in POSEIDON classification group 1, sub group 2a and compare assisted reproductive technology outcomes between luteal phase and follicular phase ovarian stimulation.&#x0D; Materials and Methods: In this cross-sectional study, 10 women with age &lt; 35 yr, antral follicle count &gt; 5, and anti-müllerian hormone &gt; 1.2 ng/mL were enrolled. All participants received conventional antagonist protocol in the follicular phase and only the cycles with retrieved oocytes &lt; 4 in this phase included. The luteal phase ovarian stimulation was initiated from the day of first oocytes retrieval by 300 IU of human menopausal gonadotropin / day. When dominant follicles amounted to 14 mm in mean diameter, 0.25 mg/day of gonadotropin-releasing hormone antagonist was initiated and 10,000 IU human chorionic gonadotropin was injected when at least two follicles with a mean diameter of 17 mm were observed. Oocyte retrieval was carried out 34-36 hr following human chorionic gonadotropin injection. Finally, a comparison was made between the two phase in terms of the number of retrieved oocytes as well as the number of obtained embryos and fertilization rates.&#x0D; Results: Numbers of retrieved oocytes (p = 0.004), mature oocytes (p = 0.016), and embryos (p = 0.013) was significantly higher in luteal phase in compared with follicular phase. Quality of embryos was similar in two phases.&#x0D; Conclusion: Double stimulation protocol can increase number of retrieved oocytes in unexpected PORs.&#x0D; Key words: Dual stimulation, Poor responder, POSEIDON classification, Luteal-phase, Follicular phase, Ovarian stimulation.</jats:p>

Do we overlook predictive factors in Poseidon 1 patients? A retrospective analysis co-evaluating antral follicle counts & diameters

“…Therefore, each follicular wave may show fluctuations in antral follicle count, and COS outcome may change cycle by cycle. Eftekhar et al [ 21 ] studied dual stimulation in patients with uIOR. They reported that the number of collected oocytes was higher in luteal phase stimulation than the follicular phase stimulation in patients with uIOR (Respectively; mean oocyte number; 9.2 + 6.8 vs. 1.9 + 1.1).…”

GnRH agonist trigger in poor prognosis patients undergoing a multicycle approach through DuoStim or consecutive stimulations: a SWOT analysis

“…From a literature review, 34 studies were published regarding the double stimulation approach in patients undergoing IVF treatment (Table 1). Among them, 23 studies used GnRH agonist trigger for final oocyte maturation in the first stimulation [3,4,5 ▪ ,7,8,10,11,14–23,24 ▪ ,25–29], six studies used hCG (3 rec-hCG and 2 u-hCG) [30–35], and five studies did not specifically distinguish the type of the trigger (GnRH-a ± hCG or hCG) [13,36–39]. GnRH agonist is the most common agent used for triggering and this tendency might depend on the putative negative effect exerted by the longer half-life of hCG on follicle growth during the subsequent LPS [18].…”

Dual Trigger with Gonadotropin-releasing Hormone Agonist and Human Chorionic Gonadotropin Improves Live Birth Rate for Women with Expected Normal Ovarian Response in Gonadotropin Releasing Hormone Antagonist Cycles: Retrospective Study

“…13 There are meagre number of studies in literature evaluating the effects of dual triggering on IVF outcomes in various subgroups of patients such as hyper-responder, normo-responder or poor-responder women. 5,6,11,[14][15][16][17][18][19][20][21][22][23][24][25] Furthermore, studies reporting live birth rates, the ultimate goal of infertility treatment, in dually triggered women with expected normal ovarian response are even scarcer. 5,6,11,21,23,25 Therefore, current amount of evidence is not adequate to recommend or argue against the use of dual triggering particularly in women with predicted normal ovarian response.…”