A step forward for IVF patients with a poor response to treatment

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Fertility patients who have a poor response to ovarian stimulation pose a stubborn challenge in IVF. Few eggs are collected, success rates are low, and various treatments are often needed to achieve pregnancy (if applicable). Clinical guidelines indicate that increasing the dose of drugs for stimulation or applying any of the complementary therapies has little benefit. Now, however, a study evaluating two cycles of ovarian stimulation and two collections of eggs in the same menstrual cycle may provide a real breakthrough for people responding to IVF poverty.

A randomized trial in Spain has shown that this doubles The approach, known as “DuoStim,” is as efficient as two conventional stimuli in different cycles and reduces the time to pregnancy in a group of patients who rarely have time by their side. “This is of great clinical use,” said Dr. Maria Cerrillo Martinez, who presented the results of the study at ESHRE’s annual online meeting on behalf of her colleagues at IVIRMA in Madrid. Dr. Cerrillo added that this was the first compare the efficiency of DuoStim with two conventional treatments in separate cycles.

The study was conducted throughout 2017 and 2020 in a total of 80 IVF patients scheduled for embryonic testing (PGT-A for chromosomal normality). They were all over 38 years old and their reproductive history and ovarian reserve tests predicted a low response —With few eggs collected and probably a bad result. They were randomized to two conventional stimulation cycles or to DuoStim, and the results were significantly in favor of the latter.

Although the initial “laboratory” response to stimulation was comparable between the two groups in terms of eggs collected and healthy embryos developed, there was a significant difference in the average number of days it took to develop a chromosomally normal embryo ready for transfer. The DuoStim group reached this point on an average of 23 days from the start of stimulation, while the conventional two-treatment group took an average of 44 days. There was also a trend toward a higher rate of fertilization and blastocyst formation in the DuoStim group.

From the earliest days of IVF treatment, either in a natural or stimulated cycle, treatment has always involved a single attempt in a single cycle. Stimulation has always occurred with fertility hormones known as gonadotrophins with the goal of producing multiple eggs for collection and fertilization. The idea of ​​stimulating the ovaries twice in the same cycle has seemed counterintuitive, but, according to Dr. Cerrillo, the concept is quite in tune with the biology of the ovary.

“Classically,” he explained, “only one cohort of follicles was recruited in the first ‘follicular’ phase of the cycle. However, from data from other species we know that stimulation in the second phase “luteal” cycle was also recruited Therefore, some women who had fertility preservation before cancer treatment and with little time left were stimulated as soon as they arrived at the IVF unit, and usually responded with “It’s the same principle behind DuoStim, that we can recruit a cohort of follicles any day of the cycle.”

To date, the benefits of a dual stimulation strategy appear to be concentrated in the time before pregnancy and in the generation of several eggs in a treatment group generally associated with very few. Studies to date have also shown that fewer patients have dropped out of treatment programs due to the shorter time required.

So far, the guidelines for IVF have described DuoStim only as an experimental application, but, according to Dr. Cerrillo, “we believe it is a great alternative for those who respond to the poor that were anticipated and that otherwise they may have difficulty achieving blastocyst transfer from a single egg collection. ” He added that his own clinic in Madrid now has experience in DuoStim in more than 500 patients. “Hopefully, the experimental recommendation will change with the publication of more data like ours.”

Dr. Cerrillo stressed that the dual stimulation strategy until now was mainly applicable to a group of patients in whom ovarian reserve tests — such as AMH — indicated a poor response to stimulation. “But we must also take into account the most relevant marker of the prognosis, the age of the patient. Therefore, the patients we are looking at are those with poor ovarian reserve, who often have an older maternal age,” he said.

“Therefore, if the patient responds well, we may not need more eggs or more embryos, and double stimulation would not be necessary,” Dr. Cerrillo explained. “However, it can be a good alternative in patients who respond poorly, in patients with fertility preservation with time constraints, or even in egg donors, whose goal is to maximize the number of recovered in a single treatment. ”


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More information:
Presentation 0-111, Tuesday, June 29, 2021: DuoStim strategy shortens the time to obtain a euploid embryo in patients with poor prognosis: a non-inferior randomized controlled trial

Citation: A step forward for IVF patients with a poor response to treatment (2021, June 29) recovered on June 29, 2021 at https://medicalxpress.com/news/2021-06-ivf-patients-poor -response-treatment.html

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