Duo-Stimulation is a Time and Cost-Effective Stimulation Method to Increase the Number of Usable Blastocysts and Ongoing Pregnancies

Abstract

Background: Duo-stimulation is an ART method whereby a patient undergoes two rounds of ovarian stimulation within a single menstrual cycle; a follicular phase stimulation (FPS) followed by a luteal phase stimulation (LFS) a . Previous studies have indicated that adoption of the duo-stimulation method increases the occurrence of at least one euploid blastocyst from 42% to 65.5% within a single ovarian cycle b . Additional benefits of the duo-stimulation method include both time taken to achieve similar results and, in Australia, cost a . Aim: To determine the efficacy of LPS oocyte collections, as part of a duo-stimulation cycle, in relation to; stimulation, egg collection and utilization parameters, as well as pregnancy outcomes from subsequent FET cycles. Method: A retrospective analysis of all LPS collections as part of a duo-stimulation cycle and subsequent FET cycles undertaken at Ballarat IVF between November 2016 and April 2021 was performed. Results: 129 duo-stimulation cycles were started, (FPS egg collection), with 118 of these progressing to a LPS collection. The average number of oocytes collected was similar with 4.8 eggs collected from FPS egg collections and 4.9 oocytes from LPS collections. Embryo utilization rates were increased in a LPS collection compared to an FPS collection, at 36.09 and 38.04 respectively. Ongoing pregnancy rates from subsequent FET cycles were also increased when embryos created from an LPS collection were transferred, 33.3% vs those created from an FPS cycle 30.6%. Conclusion: Egg collections performed after an LPS as part of a duo-stimulation cycle are a clinically effective method to procure more usable embryos in a short period of time. The duo-stimulation method will be of increasing benefit to those women of advanced maternal age, poor responders or undergoing fertility preservation for medical reasons. The biggest benefit to patients undergoing this method is cost related; when taking into account medicare rebates, undertaking two egg collections as part of a duo-stimulation cycle is a significantly more affordable option for patients in comparison to undertaking two subsequent stimulation cycles, with similar clinical outcomes.