Luteal phase ovarian stimulation following oocyte retrieval: is it helpful for poor responders?

Abstract

BackgroundPoor ovarian response and retrieval of no oocytes following ovarian stimulation for in vitro fertilization (IVF) is a challenging problem for both the patient and the clinician.FindingsRecent evidence indicates that folliculogenesis occurs in a wave-like fashion indicating that there are multiple follicular recruitment waves in the same menstrual cycle. This relatively new scientific concept provides new opportunities for the utilization of ovarian stimulation in women with poor ovarian response. This communication reports on the social and scientific rationale for the use of luteal phase ovarian stimulation following oocyte retrieval in the same cycle (also called double stimulation).ConclusionsData to date showed that double ovarian stimulation in poor responders provides shorter time for retrieving mature oocytes with the potential formation of good quality embryos, and thus healthy pregnancies.

Long‐acting recombinant follicle‐stimulating hormone in random‐start ovarian stimulation protocols for fertility preservation in women with cancer

“…The number of oocytes retrieved was generally satisfactory and, most importantly, we failed to observe significant differences between women starting in the follicular phase and those starting in the luteal phase. These results are perfectly in line with those recently published by other groups and indirectly confirm the validity of this approach.…”

Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve

“…Theoretically, the possibility of having a higher number of oocytes retrieved during a single menstrual cycle by fully exploiting the various follicular waves could offer higher chances to find a reproductively competent embryo, thus improving the live birth rate per attempt (Briggs et al 2015). This approach could be particularly useful in older women with severe DOR (Zhang 2015). Several researchers have wondered whether there is more than one fertile ovulation in one menstrual cycle, and some experts thought that any follicle development in the luteal phase has no clinical value (Baird 2004;McDonough 2004;Mikolajczyk et al 2004;Wettstein 2004).…”

“…Thus, within a single menstrual cycle, there can theoretically be multiple opportunities for a clinician to collect oocytes, as opposed to the conventional single cohort of antral follicles during the follicular phase (Vanden Brink et al 2013). Utilizing this concept, reproductive endocrinologists have been attempting to retrieve oocytes from poor responders using both the follicular-phase stimulation (FPS) and the luteal-phase stimulation (LPS) protocols in order to increase the number of oocytes collected in shorter period of time (Kuang et al 2014a;Zhang 2015;Liu et al 2017;Zhang et al 2017). The number of oocytes collected in IVF is a robust surrogate outcome for clinical success since there is a clear relationship between the number of oocytes collected and live birth rates across all female age groups (Sunkara et al 2011).…”

Can ovarian double-stimulation in the same menstrual cycle improve IVF outcomes?

“…The one thing they did different with this protocol was the sequential stimulation including the luteal phase. As the established protocols are unable to make the poor responder to have a normal response, this approach, called double ovarian stimulation ( Kuang et al ., 2014 ), aims to obtain the highest number of oocytes in the shortest time, thus avoiding the waste of time, crucial in this type of patient, in repeated attempts ( Zhang, 2015 ).…”