Barroso-Villa G, Valdespin-Fierro C, García-Montes L, Weiser-Smeke A, Machargo-Gordillo A, Ávila-Lombardo R

Language: Spanish
References: 22
Page: 306-311
PDF size: 195.63 Kb.

ABSTRACT

Objective: Euploid blastocyst rate comparison between ovarian stimulation in follicular vs luteal phase performed in the same menstrual cycle in patients with poor ovarian response.
Materials and Methods: Clinical, prospective and comparative study conducted at Centro de Reproducción Arcos S.C., “Nascere”, during january-july, 2019. Patients with PGT-A indication and poor ovarian response according to Bologna criteria were included. Under a short GnRH-antagonist protocol, stimulations, both in follicular and luteal phase were performed using rFSH/rLH (2:1) from day 3 of the cycle and 5 days after the first oocyte retrieval. In addition, ovulation trigger with an GnRH agonist was used, finally, on day 5-6 of embryo development, trophoctoctoderm biopsy was performed.
Results: In this study, 20 patients were included; when comparing follicular phase vs luteal phase, we found that fertilization rate was 79% (95%CI 29-46) vs 55% (95%CI 34-53), blastocysts rate was 42% (95%CI 19-44) vs 45% (95%CI 24-55) and euploid embryo rate was 100% (95%CI 44-53) vs 70% (95%CI 38-46). Only the oocyte recovery rate in metaphase II showed significant differences between both phases 40% (IC 95% 18-37) vs 59% (IC 95% 31-59), p=0.0333.
Conclusion: Biphasic ovarian stimulation (follicular/ luteal) in the same menstrual cycle (DuoStim) resulted in a higher metaphase II ooctye recovery rate during the luteal phase in comparison with the follicular phase. However, the rates of blastocysts and euploid blastocysts were similar between both phases.

REFERENCES

1. Baerwald AR, et al. A new model for ovarian follicular development during the human menstrual cycle. Fertil Steril. 2003; 80 (1): 116-22. doi: 10.1016/s0015-0282(03)00544-2

2. Baerwald AR, et al. Ovarian antral folliculogenesis during the human menstrual cycle: a review. Hum Reprod Update 2012;18(1):73-91. doi:10.1093/humupd/dmr039

3. De Mello Bianchi PH, et al. Review: follicular waves in the human ovary: a new physiological paradigm for novel ovarian stimulation protocols. Reprod Sci. 2010; 17 (12): 1067-76. doi:10.1177/1933719110366483

4. Baerwald AR, et al. Characterization of ovarian follicular wave dynamics in women. Biol Reprod. 2003; 69 (3): 1023- 31. doi:10.1095/biolreprod.103.017772

5. Kuang Y, et al. Luteal-phase ovarian stimulation case report: three-year follow-up of a twin birth. J IVF Reprod Med Genet. 2013; 1: 106. doi: 10.4172/2375-4508.1000106

6. Bentov Y, et al. An ongoing pregnancy from two waves of follicles developing during a long follicular phase of the same cycle. Fertil Steril. 2010; 94 (1): 350.e8-11. doi:10.1016/j. fertnstert.2009.12.033

7. Martínez F, et al. Comparison of starting ovarian stimulation on day 2 versus day 15 of the menstrual cycle in the same oocyte donor and pregnancy rates among the corresponding recipients of vitrified oocytes. Fertil Steril. 2014; 102 (5): 1307-11. doi:10.1016/j.fertnstert.2014.07.741

8. Ubaldi FM, et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle (DuoStim) in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation. Fertil Steril. 2016; 105 (6): 1488-95. e1. doi:10.1016/j.fertnstert.2016.03.002

9. Kuwayama M, et al. Highly efficient vitrification method for cryopreservation of human oocytes. Reprod Biomed Online. 2005; 11 (3): 300-8. doi:10.1016/s1472- 6483(10)60837-1

10. Ferraretti AP, et al. ESHRE consensus on the definition of poor response to ovarian stimulation for in vitro fertilization: The Bologna criteria. Huma Reprod. 2011; 26 (7): 1616-24. doi:10.1093/humrep/der092

11. Ubaldi F, et al. Management of poor responders in IVF: is there anything new? Biomed Res Int. 2014; 352098. doi:10.1155/2014/352098

12. Tsampras N, Gould D, Fitzgerald CT. Double ovarian stimulation (DuoStim) protocol for fertility preservation in female oncology patients. Hum Fertil (Camb). 2017;20(4):248-53. doi:10.1080/14647273.2017.1287433

13. La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: From theory to practice. Hum Reprod Update 2014; 20: 124-40. doi:10.1093/humupd/dmt037

14. L. Hu, et al. Comparison of different ovarian hyperstimulation protocols efficacy in poor ovarian responders according to the Bologna criteria. Int J Clin Exp Med. 2014; 7: 1128-34.

15. Lin LT, et al. Luteal Phase Ovarian Stimulation May Improve Oocyte Retrieval and Oocyte Quality in Poor Ovarian Responders Undergoing In Vitro Fertilization: Preliminary Results from a Single-Center Prospective Pilot Study. Adv Ther. 2018; 35 (6): 847-56. doi:10.1007/s12325-018-0713-1

16. Vaiarelli A, et al. Double Stimulation in the Same Ovarian Cycle (DuoStim) to Maximize the Number of Oocytes Retrieved from Poor Prognosis Patients: A Multicenter Experience and SWOT Analysis. Frontiers in Endocrinology. 2018; 14; 9: 317. doi: 10.3389/fendo.2018.00317

17. Wang N, et al. Luteal-phase ovarian stimulation vs conventional ovarian stimulation in patients with normal ovarian reserve treated for IVF: a large retrospective cohort study. Clin Endocrinol (Oxf) 2016; 84(5): 720-8. doi: 10.1111/ cen.12983

18. Lin LT, et al. The use of luteal-phase ovarian stimulation for poor ovarian responders undergoing in vitro fertilization/ intracytoplasmic sperm injection-embryo transfer treatment. Taiwanese Journal of Obstetrics and Gynecology 2016; 55 (3): 307-8. doi:10.1016/j.tjog.2016.04.002

19. Moffat R, et al. Dual ovarian stimulation is a new viable option for enhancing the oocyte yield when the time for assisted reproductive technology is limited. Reprod Biomed Online 2014; 29: 659-61. doi:10.1016/j.rbmo.2014.08.010

20. Cakmak H, et al. Effective method for emergency fertility preservation: random-start controlled ovarian stimulation. Fertil Steril. 2013; 100 (6): 1673-80. doi:10.1016/j.fertnstert. 2013.07.1992

21. Kuang Y, et al. Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes (Shanghai protocol). Reproductive biomedicine online. 2014; 29 (6): 684-91. doi:10.1016/j.rbmo.2014.08.009

22. Cimadomo D, et al. Luteal phase anovulatory follicles result in the production of competent oocytes: intra-patient paired case-control study comparing follicular versus luteal phase stimulations in the same ovarian cycle. Hum Repro 2018. doi:10.1093/humrep/dey217