DuoStim Shows Comparable Efficacy but Better Efficiency than Two Conventional Stimulations in Poor/Suboptimal Responders Undergoing Vitrified Oocyte Accumulation for PGT-A

Abstract

This study compared the DuoStim protocol with two conventional follicular phase stimulations for vitrified oocyte accumulation in poor-prognosis patients undergoing PGT-A. A retrospective analysis of 112 IVF cycles was conducted, with 66 cycles among patients undergoing DuoStim (DS-Group) and 46 among patients undergoing conventional follicular phase stimulations (DF-Group). The primary outcome was the time to live birth, while secondary outcomes included clinical pregnancy rate, miscarriage rate, live birth rate, and cumulative live birth rate. The final analysis included 66 patients in the DS-Group and 40 in the DF-Group, as 6 women (13%) in the DF-Group discontinued treatment after the first stimulation. Oocyte yield was similar between groups (8.4 ± 3.9 in DS-Group vs. 8.2 ± 4.0 in DF-Group, p = 0.80), as was the number of euploid blastocysts (0.9 ± 1.2 vs. 1.1 ± 1.1, p = 0.37). The cumulative live birth rate was 22.7% in the DS-Group and 25% in the DF-Group (multivariate odds ratio adjusted for maternal age and male factor: 1.05, p = 0.93). The time to live birth was significantly shorter in the DS-Group (81.5 ± 15.5 days) compared to the DF-Group (153.7 ± 78.2 days, p < 0.001). DuoStim showed similar efficacy but a shorter time to live birth.

Keywords: DuoStim; follicular phase stimulation; oocyte accumulation; oocyte vitrification; time to live birth.

Figure 1

Ovarian stimulation (OS) strategies for the treatment of poor/suboptimal responders undergoing PGT-A. Patients were suggested to undergo either two consecutive OS sessions in the same ovarian cycle (DS-Group) or two conventional OS sessions started in the follicular phase of two ovarian cycles (DF-Group). In the DS-Group, five days after the first oocyte retrieval, luteal phase stimulation was performed with an identical protocol (each square represents a day of the cycle). In the DF-Group, a variable time period after the first oocyte retrieval, a second conventional OS started in the follicular phase of a new but not always consecutive cycle was performed with an identical protocol (slanting lines represent the time period between the first oocyte retrieval and the start of the second OS). In both groups, oocyte vitrification was applied at the first OPU followed by their warming and insemination together with the fresh ones retrieved at the second OPU.

Figure 2

Timeline indicating the number of days needed (A) to obtain at least one euploid blastocyst, (B) to conclude the IVF cycle, and (C) to obtain an ongoing pregnancy (≥22 gestational weeks) in each of the two OS regimens. All times were significantly shorter using DuoStim.