Double stimulation in the same ovarian cycle, DuoStim is a relatively new protocol for patients with poor ovarian reserve undergoing IVF.
Unlike traditional IVF protocols where patients undergo a single round of ovarian stimulation with fertility drugs and egg retrieval in one menstrual cycle, in the DuoStim protocol patients undergo two rounds of ovarian stimulation and two egg retrievals in the same menstrual cycle (hence the name DuoStim).
The DuoStim protocol is designed to take advantage of the fact that the ovaries typically recruit several waves of follicles each month.
During a typical IVF cycle, fertility drugs are used to allow collection of multiple eggs and therefore the creation of multiple embryos. The DuoStim protocol makes use of the multiple wave theory in that after the first egg retrieval a second round of stimulation with fertility drugs can be started few days later, allowing a second egg collection in the same menstrual cycle. The results of published data suggest that, on average, a woman will develop one or two more follicles with the second part of DuoStim compared with the first.
In a recent study conducted by Vaiarelli A and coworkers, 100 poor prognosis patients underwent a DuoStim IVF from among 310 poor responders. This study found that both stimulation phases yielded eggs with equivalent quality, but that the second stimulation helped increase the proportion of patients who had at least one euploid (genetically normal) blastocyst from 42.3% to 65.5%.
The live birth rate increased from 7% after FPS to 15% after DuoStim.
In contrast, the live birth rate among the 197 patients that chose the regular IVF was 8%, and only 17 patients who were not pregnant returned for a second stimulation after the first attempt (the drop-out rate was 81%). The rate of patients with one or more euploid blastocysts for transfer increased from 14% after conventional stimulation to 31% with DuoStim.
It is important to note that all the embryos obtained via the DuoStim protocol need to be frozen, and therefore have to be transferred in a subsequent frozen embryo transfer cycle.
At VCRM we have created a special pricing package to offset some of the costs compared with the costs of two separate IVF cycles.
For patients interested in the DuoStim IVF protocol, we encourage you to make an appointment with Dr Sharara to determine if this strategy is the right one for you.