Luteal phase ovarian stimulation for poor ovarian responders

Abstract

ObjectiveTo compare the clinical outcomes of follicular versus luteal phase ovarian stimulation in women with poor ovarian response (Bologna criteria) undergoing IVF.MethodsThis retrospective study investigated 446 patients submitted to 507 cycles in three groups. First, the two larger cohorts were examined: 154 patients treated with luteal phase ovarian stimulation (Group Lu); and 231 patients administered follicular phase ovarian stimulation (Group Fo). Then the clinical outcomes of 61 patients submitted to double ovarian stimulation were analyzed. Clinical outcomes included number of retrieved oocytes, fertilization rate, cleavage rate, top-quality embryo rate, clinical pregnancy rate (CPR), and live birth rate (LBR).ResultsLonger stimulation, higher dosages of HMG, and higher MII oocyte rates were achieved in Group Lu (p<0.001). There were no significant differences in CPR and LBR between the two groups offered frozen-thawed embryo transfer (28.4% vs. 33.0%, p=0.484; 22.9% vs. 25.5%, p=0.666). In the double ovarian stimulation group, the number of oocytes retrieved in the luteal phase stimulation protocol was higher (p=0.035), although luteal phase stimulation yielded a lower rate of MII oocytes (p=0.031). CPR and LBR were not statistically different (13.8% vs. 21.4%, p=0.525; 10.3% vs. 14.3%, p=0.706).ConclusionLuteal phase ovarian stimulation may be a promising protocol to treat women with POR, particularly for patients unable to yield enough viable embryos through follicular phase ovarian stimulation or other protocols.

Successful outcome of a pregnancy derived from premature ovulation in a gonadotropin‐releasing hormone antagonist protocol: A case report

“…If normal COS is in progress, early luteinization and follicular atresia will occur after a premature LH surge 9 . However, in our case, fertilization and implantation occurred after the presumed spontaneous ovulation day, and follicular development was observed after this time.…”

“…A previous study reported that the outcome of luteal phase ovarian stimulation (LU) was higher than that for follicular phase ovarian stimulation (FO) regarding the total dosage of hMG, M2 rate, 9 number of oocytes collected, fertilization rate, and the number of day 3 embryos 10 . Additionally, a study that compared FO only to FO + LU reported that the FO + LU group had a higher number of retrieved oocytes, M2 rate, and 2 PN rate 11 .…”

Initial ovarian sensitivity index predicts embryo quality and pregnancy potential in the first days of controlled ovarian stimulation

“…Even though gonadotropin-releasing hormone analogs can prevent the premature rise [28], the potential LH surge remains [29]. When follicle recruitment during the luteal phase is performed using luteal phase ovarian stimulation (LPOS) [30], LPOS did augment oocytes pick-up and the number of Day 3 embryos, but there was no difference in the pregnancy rate [31]. Again, LPOS, coupled with MOSI, could be another option for poor responders.…”

Double or dual stimulation in poor ovarian responders: where do we stand?

“…16 Establishment of efficient vitrification techniques at every stage of preimplantation embryo development 18,19 along with our enhanced understanding of the physiologic, biochemical, and molecular mechanisms underlying antral follicular wave dynamics [20][21][22] have permitted the first description of double stimulation (DS) in 2013 23 and a modified version of DS couples with preimplantation genetic testing for aneuploidy (PGT-A), named dual stimulation (DuoStim) in 2016, 24 followed by several studies from different centers. [25][26][27][28][29][30][31][32][33][34][35] The goal of this mini-review article is to cover the available evidence of DS/DuoStim in POR patients.…”