title: 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.
abstract: OBJECTIVE
  To compare the euploid blastocyst formation rates obtained after follicular phase (FP) versus luteal phase (LP) stimulation performed in the same menstrual cycle in a preimplantation genetic diagnosis for aneuploidy testing (PGD-A) program in patients with reduced ovarian reserve.
  
  
  METHODS
  Prospective paired noninferiority observational study.
  
  
  METHODS
  Private infertility program.
  
  
  METHODS
  Forty-three reduced ovarian reserve patients undergoing a PGD-A.
  
  
  METHODS
  Both FP and LP stimulations using follicle-stimulating hormone and luteinizing hormone in combination with gonadotropin-releasing hormone (GnRH) antagonist starting on day 2 of the cycle and 5 days after the first oocyte retrieval, respectively, where GnRH agonist was used for both FP and LP ovulation triggering; a trophectoderm biopsy quantitative polymerase chain reaction-based PGD-A strategy; and single euploid blastocyst transfers during a subsequent natural cycle.
  
  
  METHODS
  
  
  
  METHODS
  euploid blastocyst rate per injected metaphase 2 (MII) oocyte; secondary outcome measures: number of cumulus-oocyte complexes (COCs), MII oocytes, and blastocysts.
  
  
  RESULTS
  Patients with an antimüllerian hormone level of <1.5 ng/mL, antral follicle count of <6 follicles, and/or <5 oocytes retrieved in a previous cycle were included. No statistically significant differences were found in the number of retrieved COCs (5.1 ± 3.4 vs. 5.7 ± 3.3), MII oocytes (3.4 ± 1.9 vs. 4.1 ± 2.5), or biopsied blastocysts per stimulated cycle (1.2 ± 1.2 vs. 1.4 ± 1.7) from FP versus LP stimulation, respectively. No differences were observed in the euploid blastocyst rate calculated either per biopsied blastocyst (46.9% vs. 44.8%) or injected MII oocyte (16.2% vs. 15.0%).
  
  
  CONCLUSIONS
  Stimulation with an identical protocol in the FP and LP of the same menstrual cycle resulted in a similar number of blastocysts in patients with reduced ovarian response. The LP stimulation statistically significantly contributed to the final transferable blastocyst yield, thus increasing the number of patients undergoing transfer per menstrual cycle.
authors.affiliation: Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy; Genetyx SRL Laboratories, Marostica, Vicenza, Italy. Electronic address: ubaldi.fm@gmail.com.
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Ubaldi
authors.affiliation: Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy; Genetyx SRL Laboratories, Marostica, Vicenza, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Capalbo
authors.affiliation: Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Vaiarelli
authors.affiliation: Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy; Dipartimento di Scienze Anatomiche, Istologiche, Medico-Legali e dell'Apparato Locomotore, Sezione Istologia ed Embriologia Medica, La Sapienza, University of Rome, Rome, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Cimadomo
authors.affiliation: Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Colamaria
authors.affiliation: Dipartimento di Scienze Anatomiche, Istologiche, Medico-Legali e dell'Apparato Locomotore, Sezione Istologia ed Embriologia Medica, La Sapienza, University of Rome, Rome, Italy; Department of Obstetric and Gynecology, University of Naples "Federico II", Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Alviggi
authors.affiliation: Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Trabucco
authors.affiliation: Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy; Department of Obstetric and Gynecology, University of Catanzaro, Catanzaro, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Venturella
authors.affiliation: BGI Shenzhen, Beishan Industrial Zone, Shenzhen, People's Republic of China; Central Queensland University, Rockhampton, Queensland, Australia.
authors.forename: Gábor
authors.initials: G
authors.lastname: Vajta
authors.affiliation: Valle Giulia Clinic, GENERA Centers for Reproductive Medicine, Rome, Italy; Ruesch Clinic, GENERA Centers for Reproductive Medicine, Naples, Italy; Genetyx SRL Laboratories, Marostica, Vicenza, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Rienzi
mesh_terms: D000328:Adult; D000782:Aneuploidy; D001755:Blastocyst / Q000502:physiology*; D015331:Cohort Studies; D004624:Embryo Transfer / Q000379:methods; D005260:Female; D005498:Follicular Phase / Q000502:physiology*; D006801:Humans; D008183:Luteal Phase / Q000502:physiology*; D008597:Menstrual Cycle / Q000502:physiology; D065851:Ovarian Reserve / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods*; D011446:Prospective Studies
keywords: Euploid blastocyst yield; PGD-A; luteal phase stimulation; oocyte collection; ovarian stimulation