DUO STIM protocol

DUO STIM PROTOCOL The duo stim protocol, in the opinion of a considerable part of the scientific community, has not yet brought certain advantages in terms of results.

This protocol was proposed to help those who respond poorly to stimulation also with the aim of obtaining more oocytes or embryos in a short time and, theoretically, achieving pregnancy sooner.

Furthermore, in this way it was possible to have a greater number of embryos at the blastocyst stage to perform PGT-a.

Finally, it was thought that since after a failed ICSI attempt many couples avoid or postpone new attempts (at least in the center where the failure occurred) it is better to make 2 ICSI attempts with stimulation and pick up as if it were only one: one with stimulation that begins when menstruation occurs and another a few days after the first pick up, i.e. in the luteal phase.

Thus, in theory, embryos would be obtained from both the first and second stimulation, all of which would be frozen for subsequent transfer.

Conversely, practice has shown that this protocol can have numerous negative effects from various points of view and has disappointed many of the expectations with which it was born.

In fact, the most recent guidelines on stimulation prepared by ESHRE (European Society of Reproductive Medicine) write that "However, except in urgent fertility preservation cases and in the absence of any strong RCT evidence, this 'duostim' approach in poor responders was consigned to research only and not recommended routinely".

That is, there are no randomized and controlled studies that indicate this protocol except in urgent cases such as those in which, due to the presence of tumors to be treated immediately, it is necessary to obtain the greatest possible number of oocytes in a very short time".

In the most recent (2023) and valid study (randomized and controlled) on Duostim compared to 2 normal stimulations, it is clear how the latter result in overall more embryos to be transferred and more pregnancies (in the left column the results of normal stimulation and in the next the Duostim results).

Furthermore, for women this protocol is very tiring both physically, economically and also psychologically.

I have met couples who, after a duo stim failure, had abandoned the idea of ​​trying again and others who were psychologically very dejected if not devastated by this experience.

In these cases, in fact, unfortunately the opposite effect to the desired one is obtained, i.e. the time to achieve pregnancy is not reduced at all but increases enormously if only because the idea of ​​trying again is abandoned.

Furthermore, it is well known that in the luteal phase there is a lot of progesterone in circulation and this can negatively affect the quality of the oocytes and embryos resulting from the second pick up.

It must also be considered that this protocol is done in many cases to perform more pre-implantation diagnoses or PGT-a.

But today we know how many doubts and problems there can be in performing PGTa: LINK TO THE VIDEO Finally, we must think about how many patients there may be who, even after Duostim, have developed embryos that reach blastocysts and how many of these turn out to have euploid embryos.

In short, I have many doubts about the advisability of performing the Duostim.