EMBRYOLOGICAL OUTCOME AND HORMONAL PROFILE AFTER DOUBLE STIMULATION IN PATIENTS WITH POOR PROGNOSIS: INTRA-PATIENT PAIRED STUDY

Abstract

Stimulation in both phases of the menstrual cycle became a new approach in poor responder patient’s management. Previous studies showed that this approach could be a good opportunity for poor-responder patients because it results in more oocytes and embryos. However, stimulation in the follicular phase makes endocrine and paracrine changes especially in the hormonal profile, which is associated with the corpus luteum function and could lead to changes in the follicle environment during luteal stimulation. Therefore, there is still need for more data about embryological outcomes and hormonal changes after DuoStim, comparing follicular versus luteal phase stimulations in the same ovarian cycle. A total of 76 patients with a reduced ovarian reserve was included in the intra-patient paired study. Inclusion criteria: age <43 years; АМH <1.2 ng/ml; AFC <6; basal FSH≥11 IU/ml. Exclusion criteria: uterine fibroids≥4 cm, deep endometriosis, cancer, BMI ≥29 kg/m2, smoking, severe male infertility. Group 1 (n=76) received stimulation on the day 2 follicular phase (FP). Group 2 (n=76) received the stimulation in the luteal phase (LP) on the 4th day after the first oocyte pick up (OPU) day in the same menstrual cycle. Plasma samples were obtained on stimulation starter day, 6 days after, on triggering and OPU day. Statistical analysis – the Mann-Whitney test, t-test, the chi-squared test; p<0.05 was considered to be statistically significant. The mean age was 36.7± 3.8 years and anti-mullerian hormone concentration was 0.94± 0.3 ng/ml in the patient’s cohort. On the stimulation starting day, the estradiol (E2) and progesterone (P) concentrations were significantly higher in group II LP stimulation patients than in a group I (Table), but then decreased and were similar in both groups on the ovulation triggering day. However, no significant differences in the embryological outcomes were found between the groups (Table). The cohorts of oocytes obtained after the luteal phase are similar to their paired follicular phase derived cohorts, and demonstrate an equal number of the blastocyst and Top-quality blastocysts. High estradiol and progesterone levels on the stimulation starting day did not affect the embryological outcome.Tabled 11 group FP (n=76)2 group LP (n=76)PEstradiol on stimulation start day (pmol/L)87,8±18,1384,27±334,44p<0.001Estradiol trig. day (pmol/L)3670,97±2896,03697,73±2231,34NSProgesterone on stimulation start day (nmol/L)0,88±0,416,7±13,3p<0.001Progesterone trig. day (nmol/L)3,8±4,95,6±4,6NSRetrieved oocytes (n)3.9±2.65.2±3.0NSMII oocytes (n)3.8±2.24.3±2.6NSBlastocysts (n)1.7±1.22.1±2.2NSTOP-blastocysts (n)1.0±0.61.6±0.6NS Open table in a new tab