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What is double stimulation in IVF?

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5 fertility expert(s) answered this question

Answer from: Patricio Calamera, MD, MSc, ObGyn

Gynaecologist, Specialist in Reproductive Medicine Ginemed
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Dual or double stimulation in IVF is not very popular as most of our patients will have a problem with ovarian reserves as they leave maternity to a later time in life. When we have a patient with really low ovarian reserves, we must get as many oocytes as possible so we can have a bigger chance of a good quality one, which is the important one for the treatment. We need good quality eggs, for good quality embryos to get our patient pregnant. So double stimulation is basically a stimulation protocol through the first part of the menstrual cycle which is the follicular part and then in the second part of the cycle which is the oocyte retrieval, until the next period begins, we go for another protocol of IVF which is similar. But we take advantage of one cycle, between two protocols on each side of the whole menstrual period.

Answer from: Valentina Denisova, MD PhD Obstetrician Gynaecologist

Gynaecologist, Fertility Specialist Next Generation Clinic
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We know that follicles can grow up not only at the beginning of the cycle but actually this cohort of follicles can start to grow up at any day of the cycle. So this is the concept of follicular waves, so we have not only the first wave but we have the second and third day of growing follicles and when we started at the beginning of the cycle, we started to stimulate the first wave of follicles. They have grown up, maybe picked up these oocytes and after an ovarian puncture a few days later, we can start the stimulation again and we will pick up oocytes twice during one menstrual cycle.

Answer from: Guillermo Quea Campos

Gynaecologist, Specialist in Reproductive Medicine Pronatal Fertility Clinics
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Double stimulation is a protocol where two stimulations are performed within the same cycle, starting the second simulation four days after performing the follicular puncture. This protocol is based on the follicular recruitment in the form of waves that occur during the ovarian cycle. The benefit is to make the most of the effect of the first stimulation on the development of new follicles. It is indicated in patients with low reserve and low response to stimulation.

Answer from: Tomas Frgala, PhD

Gynaecologist, Head Physician at UNICA Clinic - Brno
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The experience with the currently used DuoStim protocols which have been developed mainly for oncological patients at first. We’re actually following the oocyte pickup, three days later, another stimulation has started and the number of eggs, the quality of the eggs obtained through this second stimulation is, in most studies, even higher than during the first stimulation. We see that there are really or truly no restrictions that the ovaries are capable of great things but it’s unnecessary actually to push in most cases and to rush this fast. It’s also a question of the patient’s comfort with her psyche.

Answer from: Scott Nelson, Professor

Gynaecologist, Muirhead Professor of Obstetrics and Gynaecology at Glasgow Royal Fertility Clinic and Medical Director at Access Fertility
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Double stimulation is a really good stimulation strategy if you are trying to accumulate as many eggs or embryos as possible. The classic patients that that’s really good for are fertility preservation patients who are either thinking about it in terms of social egg freezing or are about to embark on chemotherapy and they’ve got a really short window of time to have, as you know, as much stored as possible. The way that we can do that is that you can essentially use on the second day of your cycle, you start your gonadotropin injections, then add in the GnRH antagonist five days later and you continue those injections for a total of about 11 days. We do give you a final trigger injection. We do the egg retrieval 36 hours later and then five days later we’re starting again. Essentially it’s kind of straight into it and then you’re doing this exact same thing again: giving daily injections of gonadotropins and an antagonist and then a further egg retrieval and that’s another two weeks in total. Actually what that means is, you’re getting two ovarian stimulation cycles, with two egg retrieval, in a period of approximately four weeks and maximizing the egg yield for that which you can then store before you’re embarking on chemotherapy for example.

About this question:

How double stimulation works and what are indications?

Who should consider proceeding with double stimulations. Is this something to consider for poor responders?

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