DuoStim/ Dual Ovarian Stimulation in IVF

UPDATED ON 17 JAN. 2025

Dealing with concerns about ovarian reserve can be overwhelming. We are a leading centre of infertility treatment, and we often come across patients who are dealing with these issues. They have a lot of questions related to this.

So we decided to come up with a detailed guide on the topic. This will help patients understand the concept and science behind ovarian reserve in detail.  We will also take a look at Dual Stimulation process for low AMH.

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What is Diminished Ovarian Reserve?

Diminished ovarian reserve (DOR) refers to a reduction in the number or quality of eggs in a woman’s ovaries. Women with this condition may face challenges in achieving pregnancy, even with assisted reproductive technologies. While age is a significant factor, younger women can also experience DOR due to genetic predispositions, medical treatments, or other health conditions.

What Causes Diminished Ovarian Reserve?

Several factors can contribute to DOR. Aging is the most common cause, as the number of eggs declines naturally over time. However, other factors like endometriosis, ovarian surgeries, chemotherapy, and radiation can also lead to reduced egg reserves. In some cases, genetic factors or autoimmune disorders may play a role.

How Do We Diagnose Diminished Ovarian Reserve?

We rely on specific tests to diagnose DOR. These include:

1. AMH Levels: Anti-Müllerian hormone levels provide a reliable indicator of ovarian reserve. Lower levels suggest a diminished reserve.
2. AFC (Antral Follicle Count): An ultrasound helps us count the small follicles in the ovaries, offering another measure of reserve.
3. FSH Levels: Follicle-stimulating hormone levels are checked on the second or third day of the menstrual cycle. Elevated FSH levels may indicate reduced ovarian function.

What are the Treatment Options for Diminished Ovarian Reserve?

Several options can help women with DOR achieve pregnancy. Let’s look at the most effective treatments:

1. Ovarian Stimulation: Ovarian stimulation involves medications to encourage the growth of multiple eggs in one cycle. Traditional stimulation methods may not always yield optimal results for women with DOR.

However, dual stimulation, which involves stimulating the ovaries twice within the same cycle, has shown promising results. This approach maximizes the number of eggs retrieved and increases the chances of successful fertilization.

2. In Vitro Fertilization (IVF): IVF remains one of the most effective options for women with DOR. In this process, eggs are retrieved, fertilized in the lab, and the resulting embryos are transferred to the uterus. While the number of eggs retrieved may be lower in DOR cases, advancements in embryo freezing and genetic testing improve success rates.

3. Egg or Embryo Donation: For women with extremely low ovarian reserves, egg or embryo donation offers a viable pathway to parenthood. Donor eggs from a younger woman are fertilized with the partner’s sperm, and the resulting embryos are transferred to the recipient’s uterus. This option provides a high success rate and allows many women to experience pregnancy and childbirth.

How Can Lifestyle Changes Help?

Although medical treatments play a crucial role, lifestyle changes can also support ovarian health. Maintaining a healthy weight, avoiding smoking, reducing stress, and consuming a nutrient-rich diet may enhance overall reproductive health. Incorporating antioxidant-rich foods and staying physically active can further support hormonal balance.

When Should You Seek Help?

If you’ve been trying to conceive without success for six months to a year, it’s time to seek professional advice. Early evaluation and intervention can make a significant difference. Even if you’re not planning to conceive immediately, consulting with Dr. Jay Mehta, a fertility specialist in Mumbai, can give you a clearer understanding of your ovarian reserve and assist in future family planning considerations.

What Makes Dual Stimulation Effective?

Dual stimulation involves two separate stimulation phases within the same menstrual cycle—one during the follicular phase and the other during the luteal phase. This method allows us to retrieve more eggs, increasing the likelihood of obtaining high-quality embryos. It’s particularly beneficial for women with DOR, as it maximizes the limited ovarian potential.

How Do We Perform Dual Stimulation?

We begin with ovarian stimulation on the second or third day of the menstrual cycle. After retrieving the eggs from this phase, we initiate the second stimulation phase. This second round typically starts three to five days after the first retrieval.

Both phases involve similar medications and monitoring to ensure the safety and effectiveness of the process. Dual stimulation not only increases the egg yield but also provides more opportunities for embryo freezing and subsequent transfers.

Are There Risks Involved?

Like any medical procedure, treatments for DOR carry certain risks. Ovarian stimulation can lead to ovarian hyperstimulation syndrome (OHSS), although this is rare in women with DOR. Other potential risks include multiple pregnancies and mild side effects from medications, such as bloating or mood changes. However, with careful monitoring, these risks are minimized.

Can Natural Conception Still Happen?

While the chances of natural conception decrease with DOR, it’s not entirely impossible. Some women may conceive naturally if they have a regular menstrual cycle and ovulate consistently. However, medical assistance improves the odds significantly, especially as time is a critical factor in managing DOR.

How Do We Support Our Patients?

We believe in a personalized approach. Every case of DOR is unique, so we tailor our treatments to meet individual needs. Our team provides continuous support, ensuring you feel informed and comfortable throughout the process. We stay updated on the latest advancements to offer you the best possible care.

Wrapping Up 

Dealing with diminished ovarian reserve can feel challenging, but it’s not the end of the road. Multiple treatment options, from dual stimulation to IVF, offer hope and possibilities. Our experts are here to guide you every step of the way.

If you have questions or need assistance, don’t hesitate to reach out. We’re always ready to help you explore your options and achieve your dream of parenthood. Make your reproductive health your priority and do not hesitate to reach out.

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