DUOSTIM or double-ovarian-stimulation for patients with diminished ovarian reserve.
Is it possible to become a mom if I have a diminished ovarian reserve? Our answer is yes, conceiving and becoming a mother is possible even if you have a low ovarian reserve, though sometimes we need help from assisted reproduction techniques to achieve a pregnancy.
One of these assisted reproduction techniques is called DUOSTIM, or a double ovarian stimulation, which we’ll discuss here.
What is DUOSTIM? A double ovarian stimulation
It is an ovarian stimulation strategy meant to achieve a greater number of eggs and, as a result, a greater number of embryos, in a shorter period of time than usual. This process is carried out with the goal of improving cumulative live-birth rates.
It involves performing two ovarian stimulations and two egg retrievals in the same ovarian cycle. The first egg retrieval procedure is carried out on day 10, 11 or 12 of the hormone administration which was started on cycle day 1, 2 or 3; the second egg retrieval is performed on day 12, 13 or 14 of the next round of hormone administration.
After the first egg retrieval, we normally wait about three to five days before starting the second ovarian stimulation with hormones and then performing the second egg retrieval about 12 to 14 days later.
So, how long does this double ovarian stimulation take? Both egg collection procedures are carried out over a period of about 30 to 40 days. To compare: if two rounds of traditional ovarian stimulation had been carried out, we would have been looking at a longer timeframe as each round of hormone administration would have to start at the beginning of two consecutive menstrual cycles.
This process is based on the belief that two or three waves of egg production can occur during a single ovarian cycle:
- At the beginning of the period, which is the first wave that the standard protocol makes use of.
- Around the time of ovulation.
- During the luteal phase, or post-ovulation.
The luteal phase is when the recruitment of additional eggs begins during the second round of stimulation (the first egg collection would be viewed as ovulation). It has been shown that the maturity and chromosome makeup of the eggs collected in this phase are similar to the quality of the eggs recruited in the first egg retrieval.
When is a DUOSTIM protocol recommended?
The DUOSTIM protocol is recommended in the following cases:
- Females with diminished ovarian reserve, confirmed by ultrasound and/or a low anti-müllerian hormone value, who want to maximise the number of eggs available.
- Females of advanced maternal age who wish to carry out pre-implantation genetic testing and want to maximise the number of embryos available for screening.
- Females who have been diagnosed with cancer and who wish to urgently preserve their fertility before undergoing radiotherapy or chemotherapy.
Advantages of DUOSTIM, or double ovarian stimulation
- A greater number of eggs viable for fertilisation are obtained (i.e., mature eggs, also known as metaphase II), in a shorter period of time. It’s an option to be considered when a patient wishes to carry out pre-implantation genetic testing as it increases the number of eggs available to work with and, as a result, increases the number of embryos available for the embryo biopsy.
Disadvantages of DUOSTIM, or double ovarian stimulation
- Two egg collection procedures and the administration of sedation twice in a short period of time is a relative disadvantage: this is owing to the fact that sometimes higher doses of hormones are used during the second round of stimulation, and other times patients need more days of stimulation than they needed in the first round before they’re ready for the second egg collection.
- The financial cost is higher.
Have we answered all your questions? Do you still have doubts regarding a double ovarian stimulation?
If you’re considering starting fertility treatment, or are simply interested in receiving information, you can request an appointment for an initial assessment of your case. This first appointment is completely cost-free and you can visit us in person or connect virtually and speak with us from the comfort of your home.