Reproductive Medicine Center, The First Affiliated Hospital of Naval Medical University, Shanghai, China.
PeerJ. 2023 May 5;11:e15296. doi: 10.7717/peerj.15296. eCollection 2023.
Dual/double stimulation (DS) is an ovarian stimulation strategy that has emerged in recent years; it is characterized by two rounds of ovarian stimulation and oocyte retrieval in the same menstrual cycle. DS can greatly shorten the time required to obtain valid embryos in assisted reproduction. For fertility preservation, DS can speed up oocyte storage process. However, factors influencing luteal phase ovarian stimulation (LPS) outcomes in DS have not been elucidated.
A total of 156 cycles from 78 cases were studied. Patients were grouped and analyzed according to their follicular phase ovarian stimulation (FPS) types. Female ages, ovarian stimulation protocols, number of oocytes retrieved, embryo quality were recorded. Comparisons of outcomes were conducted between different groups.
Our study found that LPS obtained similar outcomes to follicular phase stimulation (FPS), and that the choice of FPS protocol affected the efficiency of LPS, the antagonist protocol and progestin-primed ovarian stimulation (PPOS) protocol resulted in better embryo outcomes in LPS. In LPS of DS, sufficient stimulation duration was the guarantee of embryo quality (number of available embryos: β = 0.145, 95% CI [0.078-0.211], = 0.000; number of high-quality embryos: β = 0.114, 95% CI [0.057-0.171], = 0.000).
This study provided ideas for the precise use of DS. We suggest to further expand the sample size of DS in the future, conduct prospective controlled studies, unify the sample size of each subgroup, include the ovarian reserve of patients in the grouping basis, and exclude the influence of male factors. We hope that this study will help further refinement of DS so as to maximize patient benefits from it.
When the DS strategy is considered in the follicular phase, the antagonist protocol and PPOS protocol are more recommended for better embryo outcomes in LPS. During LPS, adequate ovarian stimulation duration is the most important guarantee for LPS efficiency.
双重/双刺激（DS）是近年来出现的一种卵巢刺激策略；其特点是在同一个月经周期内进行两轮卵巢刺激和卵母细胞采集。DS 可以大大缩短辅助生殖中获得有效胚胎所需的时间。对于生育力保存，DS 可以加速卵母细胞储存过程。然而，影响 DS 黄体期卵巢刺激（LPS）结果的因素尚未阐明。
对 78 例患者的 156 个周期进行了研究。根据卵泡期卵巢刺激（FPS）类型对患者进行分组和分析。记录女性年龄、卵巢刺激方案、获卵数、胚胎质量。对不同组间的结果进行比较。
我们的研究发现，LPS 获得的结果与卵泡期刺激（FPS）相似，FPS 方案的选择影响 LPS 的效率，拮抗剂方案和孕激素预处理卵巢刺激（PPOS）方案可改善 LPS 中的胚胎结局。在 DS 的 LPS 中，充分的刺激持续时间是胚胎质量的保证（可利用胚胎数：β=0.145，95%CI[0.078-0.211]， =0.000；优质胚胎数：β=0.114，95%CI[0.057-0.171]， =0.000）。
本研究为 DS 的精确应用提供了思路。我们建议未来进一步扩大 DS 的样本量，进行前瞻性对照研究，统一各亚组的样本量，在分组基础上纳入患者的卵巢储备情况，并排除男性因素的影响。我们希望本研究有助于进一步完善 DS，从而最大限度地使患者受益。
在卵泡期考虑 DS 策略时，更推荐拮抗剂方案和 PPOS 方案以获得 LPS 中更好的胚胎结局。在 LPS 期间，充足的卵巢刺激持续时间是 LPS 效率的最重要保证。
