In this webinar session, Dr Halyna Strelko, Chief physician, Reproductive specialist at IVMED, Kyiv, Ukraine, discussed ‘double or multi-stimulation’ protocols, how it works, and what happens during this phase of your IVF journey.
Our current stimulation protocols are based on the traditional human follicular dynamics theory. According to this theory, follicles continuously grow, but recent advancements have revealed a different paradigm called “follicular waves.” This paradigm shows that follicles grow in groups, with the discovery of two or three waves being common, depending on age.
The new paradigm of human follicular dynamic, which we call follicular waves, was revealed using a sequential ultrasound examination.
Understanding follicular waves is crucial because it allows us to identify when more antral follicles are sensitive to stimulation, often occurring during the luteal phase after ovulation. This has sparked interest in luteal phase stimulation and double stimulation protocols, driven by improvements in cryopreservation techniques.
New stimulation regimens, based on the concept of ovarian follicular waves, have emerged, moving away from conventional approaches towards luteal phase stimulation or double stimulation. Double stimulation involves two separate stimulations and egg retrievals in one month. Concerns surrounding double stimulation include elevated progesterone levels, abnormal egg maturation, and the risk of spontaneous luteinization. However, research findings have shown promise.
Recent studies suggest that increased serum progesterone levels may be associated with poor embryo quality.
Efforts to enhance stimulation protocols include synchronizing follicles in the luteal phase and adding luteinizing hormone (LH) in second-phase stimulation to counteract the negative influence of high progesterone levels.
A meta-analysis of double stimulation for patients with poor ovarian response indicates that it can significantly increase the total number of eggs retrieved without compromising quality. Double stimulation appears most beneficial for egg donation patients, poor responders, and fertility preservation cases. It can reduce treatment duration and dropout rates, making it a valuable option for certain patients.
While double stimulation holds promise, further research is needed to fully understand its impact on egg maturation and reproductive potential. The cost-effectiveness and obstetrical outcomes also require more investigation.
In conclusion, double stimulation is a promising approach for specific patient categories. It has the potential to improve clinical outcomes and offer faster treatment options. However, its suitability depends on the patient’s circumstances and careful consideration of various factors.
