Evaluation of the Consequences of Double Ovarian Stimulation Through Shanghai Protocol in Patients With Poor Ovarian Respond

Purpose: This prospective study is aimed at assessing the consequences of double ovarian stimulation through Shanghai protocol in women diagnosed as poor ovarian responders (POR), compared with the conventional IVF. Methods: : A total of 84 women diagnosed as POR were divided into two groups, including those who underwent conventional IVF protocol (N=42) and or Shanghai protocol (N=42). In Shanghai protocol, ovarian stimulation was firstly done in the early follicular phase and secondly in the luteal phase of the same ovarian cycle after the first oocyte retrieval. For primary ovarian stimulation, Letrozole 2.5 mg/day and Clomid 25 mg/day were administered for 4 consecutive days from cycle day 2 onwards. Results: : After treatment, 1 to 5 oocytes were retrieved in 34 women (85%) underwent Shanghai protocol, which was significantly higher than its rate in the conventional IVF group [26(61.90%), p=0.02]. Subsequently, 33 women (82.50%) could develop 61 live embryos at the end of the second stimulation, which was significantly higher than its rate in another group [50%, P=0.002]. The rates of Metaphase II oocytes (60.82%) and high-quality embryos (93.44%) obtained during Shanghai protocol were significantly higher than their rates in conventional IVF (45.24% and 68.42%, respectively, p<0.05). Eventually, the clinical pregnancy success rate was significantly higher in women underwent Shanghai protocol (42.50%) than those underwent conventional IVF (19.05%) [p=0.03]. Conclusion: POR women underwent the double ovarian stimulation during Shanghai protocol-based IVF achieved the higher rates of high-quality retrieved oocytes, embryos, and successful pregnancy, compared with those who had underwent the conventional IVF.