Second stimulation in the same ovarian cycle: an option to fully-personalize the treatment in poor prognosis patients undergoing PGT-A

• Published in: Journal of assisted reproduction and genetics 2022-03, Vol.39 (3), p.663-673
• Main Authors: Vaiarelli, Alberto, Cimadomo, Danilo, Gennarelli, Gianluca, Guido, Maurizio, Alviggi, Carlo, Conforti, Alessandro, Livi, Claudia, Revelli, Alberto, Colamaria, Silvia, Argento, Cindy, Giuliani, Maddalena, De Angelis, Carlo, Matteo, Maria, Canosa, Stefano, D’Alfonso, Angela, Cimadomo, Valentino, Rienzi, Laura, Ubaldi, Filippo Maria
• Format: Article
• Language: English
• Subjects: Aging; Aneuploidy; Assisted Reproduction Technologies; Blastocyst - physiology; Blastocysts; Cost analysis; Embryo Transfer - methods; Female; Fertilization in Vitro; Genetic Testing; Gonadotropin-releasing hormone; Gonadotropins; Gynecology; Human Genetics; Humans; Medicine; Medicine & Public Health; Menstrual Cycle - physiology; Ovaries; Patients; Pituitary (anterior); Pregnancy; Prognosis; Reproductive Medicine; Sperm
• ISSN: 1058-0468; 1573-7330
• DOI: 10.1007/s10815-022-02409-z

Purpose Our primary objective was to assess whether immediately undergoing a second stimulation in the same ovarian cycle (DuoStim) for advanced-maternal-age and/or poor-ovarian-reserve (AMA/POR) patients obtaining ≤ 3 blastocysts for preimplantation-genetic-testing-for-aneuploidies (PGT-A) is more efficient than the conventional-approach. Methods All AMA/POR patients obtaining ≤ 3 blastocysts after conventional-stimulation between 2017 and 2019 were proposed DuoStim, and 143 couples accepted (DuoStim-group) and were matched for the main confounders to 143 couples who did not accept (conventional-group). GnRH-antagonist protocol with recombinant-gonadotrophins and agonist trigger, intra-cytoplasmatic-sperm-injection (ICSI) with ejaculated sperm, PGT-A and vitrified-warmed euploid single-blastocyst-transfer(s) were performed. The primary outcome was the cumulative-live-birth-delivery-rate per intention-to-treat (CLBdR per ITT) within 1 year. If not delivering, the conventional-group had 1 year to undergo another conventional-stimulation. A cost-effectiveness analysis was also conducted. Results The CLBdR was 10.5% in the conventional-group after the first attempt. Only 12 of the 128 non-pregnant patients returned (165 ± 95 days later; drop-out = 116/128,90.6%), and 3 delivered. Thus, the 1-year CLBdR was 12.6% ( N  = 18/143). In the DuoStim-group, the CLBdR was 24.5% ( N  = 35/143; p  = 0.01), 2 women delivered twice and 13 patients have other euploid blastocysts after a LB (0 and 2 in the conventional-group). DuoStim resulted in an incremental-cost-effectiveness-ratio of 23,303€. DuoStim was costlier and more effective in 98.7% of the 1000 pseudo-replicates generated through bootstrapping, and the cost-effectiveness acceptability curves unveiled that DuoStim would be more cost-effective than the conventional-approach at a willingness-to-pay threshold of 23,100€. Conclusions During PGT-A treatments in AMA/POR women, DuoStim can be suggested in progress to rescue poor blastocyst yields after conventional-stimulation. It might indeed prevent drop-out or further aging between attempts.