When a woman with low AMH or diminished ovarian reserve may no appropriately respond to ovarian stimulation, that could be a very difficult situation for a reproductive specialist. In such a situation, in every cycle, we try to get the maximum number of eggs or oocytes which we can obtain from a female partner.
DuoStim/Dual Ovarian Stimulation
This allows us to stimulate ovaries two times in the same cycle. The stimulation or injections would begin on the 2nd, 3rd, or 4th day of the period, and once the Egg collection is done the next possible stimulation will occur in the next month.
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DuoStim/Dual Ovarian Stimulation in IVF
2nd or 3rd day of menstrual cycle or periods. The woman has to undergo a series of injections and then the egg, pickup is done. This Egg pickup is triggered with an agonist trigger. This induces rapid luteolysis of the corpus luteum that’s formed and within 5 days of previous egg pickup, we can begin the patient for second stimulation.
You get the almost same number of eggs or probably 2-3 eggs more when stimulation is done in the luteal phase of the cycle. This has been already proven and documented.
Duotism is based on the theory of follicle recruitment or the recruitment of eggs that occurs in multiple waves in the same ovarian cycle. We try to exploit this while performing duo stim or dual stimulation.
How duo stim/Dual Ovarian stimulation is helpful?
Dual stimulation or Duostim is done in patients with
- Low AMH less than 1.
- Women with a single ovary with a reduced ovarian reserve.
- Women whose age is above 38.
- Women with severe endometriosis.
Dual stimulation in these cases has shown excellent results with wonderful outcomes. On average in the category of women with poor ovarian stimulation responders or women with low ovarian reserve, the average success rate of taking home healthy babies following assisted reproduction is going to be 15-20%. This technique allows women to have a child with their own eggs.
Otherwise, women with Low AMH, poor ovarian reserve, multiple in vitro fertilization failures, low antral follicle count these patients are typically counseled for third-party reproduction. Due to religious beliefs, ethical beliefs, and a variety of other reasons, women are not willing to go for oocyte donation. This should be kept in mind while counseling these couples.
Duo stim / Dual stimulation when done correctly is very effective in women with low AMH. The quality of oocytes obtain in the 2nd phase or luteal phase is 5-10% better in quality than oocytes obtained in follicle phase stimulation. This technique requires an understanding of reproductive endocrinology and if applied correctly it gives an excellent result in women with low AMH.
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Dr. Jay Mehta
Fertility and IVF Specialist
Dr. Jay Mehta is the Scientific Director of Shree IVF Clinic. He is a well-known Fertility and IVF Specialist and also among few doctors in the country who specializes in Embryology and Andrology.