By Dr. Pedro Royo Manero (Gynecologist – License No. 312203918).
Ovarian stimulation is one of the first stages of assisted reproduction treatments and is carried out to promote the development of several follicles within the same menstrual cycle in order to obtain the highest possible number of oocytes. In cases of limited ovarian response or when time is a critical factor, medical professionals may establish alternative strategies to optimize each attempt. One of these strategies is double ovarian stimulation, known as DuoStim.
This technique makes it possible to perform two stimulations within the same menstrual cycle, something that for many years was considered unfeasible but is now applied in very specific situations.
When double ovarian stimulation is chosen as part of a treatment, a first stimulation is carried out during the follicular phase of the menstrual cycle, as in conventional treatments, followed by a second stimulation during the luteal phase (after ovulation and before menstruation), once the first ovarian puncture has been performed. These two phases take place consecutively within the same month, without the need to wait for a new menstrual cycle.
This approach takes advantage of the ovary’s ability to recruit follicles at different moments of the cycle and maximizes the possibility of obtaining a higher total number of oocytes in a shorter period of time, which is particularly useful when every oocyte counts.
For a long time, it was believed that the ovary could only respond to one stimulation per menstrual cycle. However, it has been shown that there are multiple waves of follicular growth throughout the cycle and that the ovary can respond more than once without compromising the quality of the oocytes obtained.
DuoStim is not a technique applied routinely to all patients and is usually reserved for very specific profiles, such as women with low ovarian reserve, patients with poor response to conventional stimulation, or situations in which time is a determining factor, such as advanced maternal age or before starting oncological treatments that may affect fertility. This type of double stimulation can only be used if the patient meets certain criteria, which must be individually assessed by the physician.
In these cases, the possibility of performing two consecutive stimulations allows treatment to be accelerated and increases the number of options without unnecessarily prolonging timelines.
In double ovarian stimulation protocols, it is common to use the so-called “freeze-all” strategy. As two consecutive stimulations are carried out within the same cycle, the oocytes or embryos obtained after the first puncture are vitrified, since the endometrium during the luteal phase is usually not in optimal conditions for a fresh transfer.
In this way, the embryos are preserved and the transfer is scheduled for a later cycle, when the uterus is properly prepared and synchronized.
This treatment clearly reflects how assisted reproduction has evolved towards an increasingly personalized approach. Compared to standard protocols, techniques such as DuoStim make it possible to adapt treatment to the biological characteristics and personal circumstances of each patient, with the aim of optimizing outcomes and always ensuring maximum safety.
As with any reproductive technique, the key lies in studying each case individually and providing close follow-up to choose the most appropriate strategy for achieving the best possible results.
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DATA CONTROLLER: IVF SPAIN ALICANTE S.L.U (hereinafter IVF-Life)
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