Double Stimulation in Women With Low Prognosis in ART

Impact of Double Stimulation (DuoStim) in Women Affected by Low Prognosis to Assisted Reproductive Technologies

The main objective of this study is to compare the cumulative ongoing pregnancy rates of two different IVF protocols in women candidate for ART characterized by low prognosis.

The patients will be allocated into two groups: control and study group _ In study group, patients will be treated by DuoStim protocol: The first phase of ovarian stimulation is started on the second day or third day of period. GnRH agonist will be used to trigger when at least two follicles ≥ 17 mm. Approximately 36 hours later, oocytes will be retrieved vaginally under ultrasound monitoring and ICSI will be performed. Five days later after oocyte retrieval, the second stimulation will be started. All embryos will be cryopreserved.

_ In control group, patients will be treated with antagonist protocol: The cycle of ovarian stimulation is started on the second day or third day of period. hCG will be used to trigger when at least two follicles ≥ 17 mm. Approximately 36 hours later, oocytes will be retrieved vaginally under ultrasound monitoring and ICSI will be performed. If serum progesterone on the day of trigger ≥ 1.5 ng/ml, all embryos will be cryostored; otherwise, fresh embryos will be transferred.

Inclusion Criteria:

• Age ≤ 40.
• AMH ≥ 0.3 ng/ml and ≤ 1.2 ng/ml.
• OR 3 ≤ AFC ≤7.
• Normal shape of uterus (based on ultrasound).
• Body mass index within 28 - 37 kg/m2

Exclusion Criteria:

• Asherman's syndrome.
• Endometriosis.
• Leiomyomas distorting the endometrium
• Sperm extracted from surgical procedures (i.e. PESA, TESE).
• Patients refuse to continue participating in the study.
• Patients injected with wrong dose of gonadotropins during the treatment.
• Serious complications or accidents arise forcing the patients to discontinue the treatments.
• Ovarian surgery
• Previous chemotherapy or pelvic irradiation