Abstract
A panel of experts known as the POSEIDON group has recently redefined the spectrum of poor responder patients and introduced the concept of suboptimal response. Since an ideal management for these patients is still missing, they highlighted the importance of tailoring the ovarian stimulation based on the chance of each woman to obtain an euploid blastocyst. Interestingly, a novel pattern of follicle recruitment has been defined: multiple waves may arise during a single ovarian cycle. This evidence opened important clinical implications for the treatment of poor responders. For instance, double stimulation in the follicular (FPS) and luteal phase (LPS) of the same ovarian cycle (DuoStim) is an intriguing option to perform two oocyte retrievals in the shortest possible time. Here, we reported our 2-year experience of DuoStim application in four private IVF centers. To date, 310 poor prognosis patients completed a DuoStim protocol and underwent IVF with blastocyst-stage preimplantation-genetic-testing. LPS resulted into a higher mean number of oocytes collected than FPS; however, their competence (i.e., fertilization, blastocyst, euploidy rates, and clinical outcomes after euploid single-embryo-transfer) was comparable. Importantly, the rate of patients obtaining at least one euploid blastocyst increased from 42.3% (n = 131/310) after FPS to 65.5% (n = 203/310) with the contribution of LPS. A summary of the putative advantages and disadvantages of DuoStim was reported here through a Strengths–Weaknesses–Opportunities–Threats analysis. The strengths of this approach make it very promising. However, more studies are needed in the future to limit its weaknesses, shed light on its putative threats, and realize its opportunities.
Highlights
In IVF, poor response to controlled ovarian stimulation (COS) represents an important issue, which may affect 9–24% of the infertile women [1]
The aim of this paper is to provide an update about the IVF management of poor responders, as well as to describe and encourage the use of novel strategies, especially for the patients of POSEIDON groups 3 and 4, to increase the cumulative live birth per IVF treatment
The evidence that multiple waves of follicle recruitment may arise during a single ovarian cycle in women opened important clinical implications for the treatment of poor prognosis patients
Summary
In IVF, poor response to controlled ovarian stimulation (COS) represents an important issue, which may affect 9–24% of the infertile women [1]. Such a wide range is indicative of a heterogeneous population of patients. At least two of the following characteristics must be present to define “a poor responder patient”: advanced maternal age (>40 years) and/or scarce response to a previous conventional stimulation (≤3 oocytes) and/or reduced ovarian reserve (antral follicle count, AFC < 5–7 follicles, and/or AMH < 1.1 ng/ml). An efficient prediction of the ovarian response is, pivotal to define a tailored-COS for each patient, especially poor responders, which should be based upon AFC and AMH, namely, the most widely used biomarkers at present [10]
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