Sequential Ovarian Stimulation for POSEIDON Group 3-4 Poor Responders

Abstract

Objective: The most important issue in both the follicular and luteal phases of the same ovarian cycle (DuoStim) is determining the most appropriate stimulation protocol for the 1st OPU (follicular phase) and 2nd OPU (the luteal phase). We analyzed the POSEIDON 3-4 groups undergoing sequential stimulation treatment to investigate the effects on oocyte number, oocyte maturation, fertilization, and blastocyst rate. Material and Method: POSEIDON 3-4 groups were scheduled for a sequential stimulation protocol in a private fertility center. Ovarian stimulation was started with a fixed dose of 300 IU/day of a combination of gonadotropins (150 IU recFSH+75 IU rec LH along with an additional 75 IU rec FSH). Medroxy progesterone acetate 10mg/day using. Final oocyte maturation was induced with 0.2 mg triptorelin. Two days after the first retrieval, the second stimulation was initiated with the same protocol and daily dose. Ovulation was induced with a bolus of GnRHa with rec hCG (250mcg). One or two cleavage or blastocyst stage embryos were calculated. Results: 49 POSEIDON 3-4 patients were included in the final analysis, representing 98 cycles. The mean age was 34.4 ±6 years, and the serum AMH level was 0.85 ±0.2 ng/ml. The duration of stimulation (8.8±3.1 vs 8.2±3.6 days) and the total dose of gonadotropin used (2829±840 vs 1846±421 IU) were comparable. The mean number of oocytes retrieved (1.9 vs 2.1) and M2 oocytes (1.4 vs 1.7) were comparable. Mean oocyte maturation rates per cycle were also comparable (75.6% vs. 77.5%, respectively, p=0.8). Mean fertilization rates per cycle did not differ for oocytes collected (84.7% vs. 68.6%, p=0.06). The mean blastocyst rate per cycle was 63% and 69% respectively (p=0.8). At least 1 embryo was retrieved after the 1st and 2nd cycle or both in 79.6% of patients after DuoStim. Conclusion: DuoStim can be an effective method to reduce the time to achieve embryo and blastocyst, especially in POSEIDON 3-4. Also, with the sequential stimulation protocol, we can obtain the same number of oocytes and blastocyte rates in both cycles, and this methodology can save patients time. Further large-scale randomized controlled trials are recommended, especially for the POSEIDON 3-4 groups.