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

Maryam Eftekhar, Banafsheh Mohammadi, Mohammadi B, Parisa Khani, Lahijani MM, Maryam Mortazavi Lahijani
International journal of reproductive biomedicine · 2020 · vol. 18(6) , pp. 465–470 · doi:10.18502/ijrm.v13i6.7287 · PMID:32754681 · PMC7340986
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In unexpected poor responders, double stimulation within the same cycle yielded significantly more retrieved oocytes, mature oocytes, and embryos during the luteal phase compared to the follicular phase, while embryo quality remained similar.

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This cross-sectional study evaluated the efficacy of dual ovarian stimulation within a single menstrual cycle for young women classified as unexpected poor responders under the POSEIDON group 1, sub-group 2a. The researchers compared outcomes between follicular phase and luteal phase ovarian stimulation in ten participants who had previously retrieved fewer than four oocytes during conventional treatment. Results indicated that luteal phase stimulation yielded significantly higher numbers of retrieved oocytes and embryos compared to the follicular phase, while embryo quality remained comparable between the two phases. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

BACKGROUND: Poor ovarian response management is a complex and controversial issue in the field of reproductive medicine. 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. MATERIALS AND METHODS: In this cross-sectional study, 10 women with age 5, and anti-müllerian hormone > 1.2 ng/mL were enrolled. All participants received conventional antagonist protocol in the follicular phase and only the cycles with retrieved oocytes < 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. 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. CONCLUSION: Double stimulation protocol can increase number of retrieved oocytes in unexpected PORs.
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For generating an adequate number of oocytes, it stands to reason to accept that double stimulation is advantageous for patients with unexpected PORs. Accumulation of oocytes in a single cycle of stimulation that helps minimize the time in which it will be performed is the greatest benefit of this protocol. Moreover, it bears the potential to allow generating a larger number of embryos, which can then be genetically evaluated, thereby favoring the final clinical result.

Coi Statement

The authors declare that there is no conflict of interest.

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