Modern therapeuthic option for enhancing oocyte yield for assisted reproductive technology in poor responders

I. Pacu, I. Tarcomnicu, C. Ionescu

Rezumat: Management of poor responders in IVF is quite a challenge as the incidence of poor ovarian responders among infertile women is increasing and despite the hudge number of papers about this topic there are insufficient evidence to recommend the best approach for these cases. The aim of the study is to evaluate the number of oocyte and pregnancy rates for poor responders using classic antagonist protocols versus the Duplex protocol that features a dual stimulation, with the second stimulation started immediately after the first oocyte retrieval. This modern approach can be succesfull used due to large availability of oocyte and embryo vitrification offering access to an emerging new realm of “no-loss cryopreservation” and bringing new options in assisted reproductive technologies. Our study compare two groups of patients, both with poor response to ovarian stimulation for IVF, according to Bologna criteria. For the first group we have used antagonist protocol using 300-450UI FSH per day, Cetrorelix 0.25mg per day starting on ovarian stimulation day 6 and GnRH of HCG trigger; for the second group with Duplex protocol we have used a similar protocol for the first stimulation and after the oocyte retrieval we started the second similar stimulation in the day of first oocyte retrieval. In the second group we have made embrio vitrification in all cases. The first and second stimulation in the second group provided similar number of oocytes and embrios, so Duplex protocol doubled the final blastocysts yield. Pregnancy rate is better in second group. Our dates are similar to those from similar literature findings but we consider these only preliminary data because of a small number of cases. The protocol was well tolerated in all cases. Duplex protocol is a modern and no risk option not only for poor responders but for cases that need a short time for fertility preservation.
Cuvinte cheie: poor responders, Duplex protocol, fertility preservation.