Polat Mehtap, Mumusoglu Sezcan, Yarali Ozbek Irem, Bozdag Gurkan, Yarali Hakan
Anatolia IVF and Women's Health Center, Ankara, Turkey.
Department of Obstetrics and Gynecology, Hacettepe University Medical School, Ankara, Turkey.
Ther Adv Reprod Health. 2021 Jun 30;15:26334941211024172. doi: 10.1177/26334941211024172. eCollection 2021 Jan-Dec.
Recent advances in our recognition of two to three follicular waves of development in a single menstrual cycle has challenged the dogmatic approach of ovarian stimulation for fertilization starting in the early follicular phase. First shown in veterinary medicine and thereafter in women, luteal phase stimulation-derived oocytes are at least as competent as those retrieved following follicular phase stimulation. Poor ovarian responders still remain a challenge for many decades simply because they do not respond to ovarian stimulation. Performing follicular phase stimulation and luteal phase stimulation in the same menstrual cycle, named as double stimulation/dual stimulation, clearly increases the number of oocytes, which is a robust surrogate marker of live birth rate in fertilization across all female ages. Of interest, apart from one study, the bulk of evidence reports significantly higher number of oocytes following luteal phase stimulation when compared with follicular phase stimulation; hence, performing double stimulation/dual stimulation doubles the number of oocytes leading to a marked decrease in patient drop-out rate which is one of the major factors limiting cumulative live birth rates in such poor prognosis patients. The limited data with double stimulation/dual stimulation-derived embryos is reassuring for obstetric and neonatal outcome. The mandatory requirement of freeze-all and lack of cost-effectiveness data are limitations of this novel approach. Double stimulation/dual stimulation is an effective strategy when the need to obtain oocytes is urgent, including patients with malignant diseases undergoing oocyte cryopreservation and patients of advanced maternal age or with reduced ovarian reserve.
我们对单个月经周期中两到三个卵泡发育波的认识取得了最新进展，这对从卵泡早期开始进行卵巢刺激以促进受精的教条方法提出了挑战。黄体期刺激获得的卵母细胞最早在兽医学中被发现，随后在女性中也有发现，其能力至少与卵泡期刺激后获取的卵母细胞相当。几十年来，卵巢反应不良者仍然是一个挑战，仅仅是因为他们对卵巢刺激没有反应。在同一个月经周期中进行卵泡期刺激和黄体期刺激，即所谓的双重刺激，明显增加了卵母细胞的数量，而卵母细胞数量是所有年龄段女性受精活产率的一个有力替代指标。有趣的是，除了一项研究外，大量证据表明，与卵泡期刺激相比，黄体期刺激后获得的卵母细胞数量显著更多；因此，进行双重刺激会使卵母细胞数量翻倍，从而显著降低患者退出率，而患者退出率是限制此类预后不良患者累积活产率的主要因素之一。双重刺激获得的胚胎相关数据有限，但对产科和新生儿结局来说是令人安心的。强制进行全冻存以及缺乏成本效益数据是这种新方法的局限性。当急需获取卵母细胞时，双重刺激是一种有效的策略，包括正在进行卵母细胞冷冻保存的恶性疾病患者以及高龄产妇或卵巢储备减少的患者。
