Journal of Shandong University (Health Sciences) ›› 2021, Vol. 59 ›› Issue (8): 61-66.doi: 10.6040/j.issn.1671-7554.0.2021.0708

Previous Articles     Next Articles

A comparative analysis of the effects of natural cycle combined with luteal ovarian stimulation and dual ovarian stimulation

CHEN Wei, GUO Qingqing, XU Jin, FANG Yuan, SUN Mei, SHENG Yan   

  1. Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250001, Shandong, China
  • Published:2021-09-16

PDF (PC)

160

Abstract: Objective To compare the pregnancy outcome and cost-effectiveness of nature cycle with luteal phase stimulation(NLPS)and dual ovarian stimulation(DuoS). Methods A total of 376 cycles in 356 patients were enrolled in this retrospective cohort study, including 137 cycles using NLPS and 239 cycles using DuoS protocols. Basic characteristics of patients, treatment variables, outcomes, average cost per cycle, and the cost-effectiveness for one good quality embryo were compared between the two groups. The luteal phase and follicular phase outcomes and cost-effectiveness ratio were also compared. Results There were no differences between NLPS and DuoS groups in the numbers of oocyte retrieval(P=0.41), two pronuclei(2PN)(P=0.74), good quality embryos(P=0.10), and the rate of clinical pregnancy(P=0.08). The cost per cycle was lower in NLPS(P<0.01), but the cost-effectiveness for one good quality embryo was better in DuoS. The numbers of oocyte retrieval, 2PN, and good quality embryos were higher after LPS(3.47±4.26 vs 1.13±1.21, Z=-8.59, P<0.01; 2.03±2.59 vs 0.62±0.87, Z=-7.77, P<0.01; 0.80±1.27 vs 0.24±0.50, Z=-6.52, P<0.01). The cost per cycle was higher in LPS, but the cost-effectiveness was also better(P<0.01). Conclusion NLPS shows same clinical outcome compared with DuoS, but has lower cost per cycle. DuoS has better cost-effective to obtain one good quality embryo. LPS contributes more to the final outcome and is more economical compared to follicular phase stimulation within the same cycle.

Key words: Luteal phase stimulation, Dual ovarian stimulation, In vitro fertilization, Clinical pregnancy, Cost-effectiveness

CLC Number: 

  • R711.6
[1] Kuang Y, Chen Q, Hong Q, et al. Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes(Shanghai protocol)[J]. Reprod Biomed Online, 2014, 29(6): 684-691.
[2] Vaiarelli A, Cimadomo D, Ubaldi N, et al. What is new in the management of poor ovarian response in IVF?[J]. Curr Opin Obstet Gynecol, 2018, 30(3): 155-162.
[3] Qin N, Chen Q, Hong Q, et al. Flexibility in starting ovarian stimulation at different phases of the menstrual cycle for treatment of infertile women with the use of in vitro fertilization or intracytoplasmic sperm injection[J]. Fertil Steril, 2016, 106(2): 334-341.
[4] Wang N, Wang Y, Chen Q, et al. Luteal-phase ovarian stimulation vs conventional ovarian stimulation in patients with normal ovarian reserve treated for IVF: a large retrospective cohort study[J]. Clin Endocrinol(Oxf), 2016, 84(5): 720-728.
[5] Zhang W, Wang M, Wang S, et al. Luteal phase ovarian stimulation for poor ovarian responders[J]. JBRA Assist Reprod, 2018, 22(3): 193-198.
[6] Guo Z, Xu X, Zhang L, et al. Endometrial thickness is associated with incidence of small-for-gestational-age infants in fresh in vitro fertilization-intracytoplasmic sperm injection and embryo transfer cycles[J]. Fertil Steril, 2020, 113(4): 745-752.
[7] Chen ZJ, Shi Y, Sun Y, et al. Fresh versus Frozen Embryos for Infertility in the Polycystic Ovary Syndrome[J]. N Engl J Med, 2016, 375(6): 523-533.
[8] Man Y, Bian Y, Zhao S, et al. The effect of different endometrial preparations on women with polycystic ovary syndrome undergoing initial frozen embryo transfer: a historical cohort analysis[J]. Acta Obstet Gynecol Scand, 2021, 100(6): 1116-1123.
[9] Gougeon A, Lefèvre B. Evolution of the diameters of the largest healthy and atretic follicles during the human menstrual cycle[J]. J Reprod Fertil, 1983, 69(2): 497-502.
[10] Adams GP, Singh J, Baerwald AR. Large animal models for the study of ovarian follicular dynamics in women[J]. Theriogenology, 2012, 78(8): 1733-1748.
[11] Ginther OJ. The mare: a 1000-pound guinea pig for study of the ovulatory follicular wave in women[J]. Theriogenology, 2012, 77(5): 818-828.
[12] Baerwald AR, Adams GP, Pierson RA. Ovarian antral folliculogenesis during the human menstrual cycle: a review[J]. Hum Reprod Update, 2012, 18(1): 73-91.
[13] 李冬宏, 卢淑庄, 林彤, 等. 黄体期促排卵在卵巢低反应高龄患者中的应用效果研究[J].生殖医学杂志, 2017, 26(10): 1041-1043.
[14] Li D, Liu Q, Chen X, et al. Analysis of embryo quality with luteal phase ovarian stimulation after failed in vitro fertilization-embryo transfer with long or ultra-long protocol[J]. J Gynecol Obstet Hum Reprod, 2019, 48(7): 527-529.
[15] Kansal Kalra S, Ratcliffe S, Gracia CR, et al. Randomized controlled pilot trial of luteal phase recombinant FSH stimulation in poor responders[J]. Reprod Biomed Online, 2008, 17(6): 745-750.
[16] Ubaldi FM, Capalbo A, Vaiarelli A, et al. Follicular versus luteal phase ovarian stimulation during the same menstrual cycle(DuoStim)in a reduced ovarian reserve population results in a similar euploid blastocyst formation rate: new insight in ovarian reserve exploitation[J]. Fertil Steril, 2016, 105(6): 1488-1495.
[17] Lu BJ, Lin CJ, Lin BZ, et al. ART outcomes following ovarian stimulation in the luteal phase:a systematic review and meta-analysis[J]. J Assist Reprod Genet, 2021, 25. https://doi.org/10.1007/s10815-021-02237-7
[18] Jin B, Niu Z, Xu B, et al. Comparison of clinical outcomes among dual ovarian stimulation, mild stimulation and luteal phase stimulation protocols in women with poor ovarian response[J]. Gynecol Endocrinol, 2018, 34(8): 694-697.
[19] Luo Y, Sun L, Dong M, et al. The best execution of the DuoStim strategy(double stimulation in the follicular and luteal phase of the same ovarian cycle)in patients who are poor ovarian responders[J]. Reprod Biol Endocrinol, 2020, 18(1):102.
[20] 韦立红, 马文红, 李忻琳, 等. 卵泡期联合黄体期促排卵对卵巢低反应患者活产率的影响[J]. 生殖医学杂志, 2019, 28(1): 36-40. WEI Lihong, MA Wenhong, LI Xinlin, et al. Effect of ovulation induction during follicular phase combined with luteal phase on live-birth rate in poor ovarian responder[J]. Journal of Reproductive Medicine, 2019, 28(1): 36-40.
[21] Sfakianoudis K, Simopoulou M, Maziotis E, et al. Evaluation of the second follicular wave phenomenon in natural cycle assisted reproduction: a key option for poor responders through luteal phase oocyte retrieval[J]. Medicina(Kaunas), 2019, 55(3): 68. https://doi.org/10.3390/medicina55030068
[22] Vaiarelli A, Cimadomo D, Trabucco E, et al. Double stimulation in the same ovarian cycle(DuoStim)to maximize the number of oocytes retrieved from poor prognosis patients: a multicenter experience and SWOT analysis[J]. Front Endocrinol(Lausanne), 2018, 9: 317. https://doi.org/10.3389/fendo.2018.00317
[23] Rashtian J, Zhang J. Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve[J]. Syst Biol Reprod Med, 2018, 64(3): 216-219.
[24] Moffat R, Pirtea P, Gayet V, et al. Dual ovarian stimulation is a new viable option for enhancing the oocyte yield when the time for assisted reproductive technnology is limited[J]. Reprod Biomed Online, 2014, 29(6): 659-661.
[25] Madani T, Hemat M, Arabipoor A, et al. Double mild stimulation and egg collection in the same cycle for management of poor ovarian responders.[J]. J Gynecol Obstet Hum Reprod, 2019, 48(5): 329-333.
[1] LI Hongwen, ZHOU Zifu, WANG Song, HUO Ran. Cost-effectiveness analysis of staged excision compared with one-stage excision of facial pigmented nevus in children [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 123-128.
[2] Lei YAN,Zijiang CHEN. Treatment of adenomyosis complicated with infertility [J]. Journal of Shandong University (Health Sciences), 2022, 60(7): 43-47.
[3] WU Richao, LIU Hong, WANG Ze, GAO Shanshan, LI Xiufang, SHI Yuhua. Pregnancy outcomes of in vitro fertilization-intracytoplasmic sperm injection-embryo transfer in women 40 years and above [J]. Journal of Shandong University (Health Sciences), 2022, 60(6): 35-39.
[4] DONG Xue, ZHAO Xia, CHENG Zijie, HAN Yi. Pharmacoeconomic evaluation of levosimendan and milrinone in the treatment of 711 patients with severe heart failure complicated with renal injury [J]. Journal of Shandong University (Health Sciences), 2022, 60(4): 91-98.
[5] DENG Xiaohui, GUO Ling. Applications and progress of immunotherapy in repeated implantation failure [J]. Journal of Shandong University (Health Sciences), 2021, 59(8): 32-37.
[6] WU Xiaolin, LI Ping. Effect of Gn stimulation duration on pregnancy outcome of IVF-ET in long GnRHa protocol [J]. Journal of Shandong University (Health Sciences), 2021, 59(7): 32-37.
[7] FENG Zhenhua, LI Yuanmei, CUI Wenjuan, SI Rui, SHENG Yan, ZHAO Han. High live birth rate in women with hypogonadotropic hypogonadism after treatment of in vitro fertilization [J]. Journal of Shandong University (Health Sciences), 2020, 58(1): 43-48.
[8] SUN Mei, CUI Wenjuan. Risk factors affecting fertility and strategies for advanced age fertility [J]. Journal of Shandong University (Health Sciences), 2019, 57(2): 23-28.
[9] YU Na, GUO Qingqing, SUN Mei, SHENG Yan, MA Zengxiang, QIN Yingying. Clinical outcomes of IVF/ICSI-ET after thyroid cancer surgical treatment [J]. Journal of Shandong University (Health Sciences), 2018, 56(9): 54-58.
[10] ZHANG Dandan, XIE Hongqiang, WU Qianqian, LI Hongchang, ZHU Yueting, LU Juanjuan, JIANG Wenjie, YAN Junhao. Clinical treatment value of preimplantation genetic screening for unexplained repeated implantation failure [J]. Journal of Shandong University (Health Sciences), 2018, 56(4): 64-69.
[11] CHEN Shiling, ZHOU Xingyu. Clinical research advances on premature ovarian insufficiency [J]. Journal of Shandong University (Health Sciences), 2018, 56(4): 1-7.
[12] LI Yun, ZHONG Wanxia, YAO Ning, HU Shuanggang, LIU Hongmao. Effects of female age on the outcome of preimplantation genetic diagnosis and screening [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(1): 60-62.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] LYU Longfei, LI Lin, LI Shuhai, QI Lei, LU Ming, CHENG Chuanle, TIAN Hui. Application of laparoscopic fine needle catheter jejunostomy in minimally invasive McKeown resection of esophageal cancer[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 77 -81 .
[2] SHAO Haigang, WANG Xuan, WANG Qing. Anatomy of the root canal system of mandibular first premolar in population of Shandong Province[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(9): 85 -89 .
[3] SHI Shuang, LI Juan, MI Qi, WANG Yunshan, DU Lutao, WANG Chuanxin. Construction and application of a miRNAs prognostic risk assessment model of gastric cancer[J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 47 -52 .
[4] HUANG Fei,WANG Huaijing,XING Yi,GAO Wei,LI Yonggang,XING Ziying,LI Zhenzhong. Protective effects of NGF and GM1 on primary sensory neurons in SD rat with sciatic nerve injury[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(4): 332 -335 .
[5] LI Yu-liang,WANG Yong-zheng,WANG Xiao-hua,ZHANG Fu-jun,ZHU Li-dong,ZHANG Wang-ming,LI Zheng,LI Zhen-jia,ZHANG Kai-xian. I implantation combined with Gemcitabine in the treatment of advanced pancreatic cancer[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(4): 393 -396 .
[6] JIANG Bao-dong,MA Xiang-xing,WANG Qing,WANG Qian,FENG Xiao-yuan,LI Ke,YU Fu-hua. Imaging parameters of multislice spiral CT venography in cerebral veins[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2008, 46(11): 1084 -1086 .
[7] TANG Fang1,2, ZHANG Yingqian3, WANG Zhiqiang4, KANG Dianmin4,
WANG Jiezhen1, XUE Fuzhong1. A 2D minimal spanning tree model of the spatial structures of natural focal disease[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2009, 47(01): 106 -110 .
[8] WANG Xiaoju1，　WANG Mingming2，　XU Wansu2,　ZHAO Shengmei3，CUI Sunan2，　LI Xiaoying2，　LIU Chunhua1
. Expression of peripheral blood lymphocyte ubiquitin mRNA in chronic HBV infection with active inflammation and its clinical significance[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2009, 47(02): 58 -61 .
[9] LI Wei,LI Dao-wei,YE Qian,GAO Shun-cui,JIANG Shu-juan.

Diagnostic value of transbronchial needle aspiration in paratracheal mediastinal lesions

[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2008, 46(11): 1063 -1065 .
[10] ZHU Xiaoli1, GUO Shuling1, SU Lei1, FENG Yuxin2, YUAN Fangshu1. Extraction of total proteins from demodex and qualification of their molecular weights[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2014, 52(5): 58 -62 .
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd