Fertility treatment should be tailored to the individual needs of every woman, especially when factors such as advanced maternal age or diminished ovarian reserve may make the journey more challenging. In this context, the DuoStim protocol, or double ovarian stimulation, offers an efficient, personalised approach that can also reduce the emotional burden of treatment.
Why consider an alternative to conventional ovarian stimulation?
For women over the age of 38 or those with poor ovarian response, conventional ovarian stimulation may not produce enough eggs or embryos to maximise the chances of success. Over the years, several strategies have been proposed, including:
- The use of androgens.
- Aromatase inhibitors.
- Oocyte accumulation.
- Selecting the optimal stimulation cycle.
However, none of these approaches has consistently demonstrated clear superiority. Many have gradually fallen out of routine clinical practice because of their limited effectiveness or the complexity of their application.
The DuoStim protocol has emerged as a well-established strategy supported by strong clinical evidence and consistent reproductive and emotional outcomes.
Key Studies Supporting the DuoStim Protocol
Vaiarelli et al. (2020)
This study compared two groups of women undergoing an IVF cycle with preimplantation genetic testing for aneuploidy (PGT-A) due to advanced maternal age:
- 100 patients underwent double ovarian stimulation (DuoStim).
- 197 patients followed the conventional protocol with a single follicular-phase stimulation.
Results
- The take-home baby rate increased from 7% to 15% with DuoStim.
- The proportion of chromosomally normal embryos increased from 14% to 31%.
- In the conventional stimulation group, 81% of patients discontinued treatment, mainly because of the emotional impact of poor prognosis and previous unsuccessful cycles.
Cerrillo et al. (2023)
A total of 80 women over the age of 38 were divided into two groups:
- 39 underwent two separate stimulation cycles in consecutive menstrual cycles.
- 41 completed the DuoStim protocol within a single menstrual cycle.
Results
- The chromosomal status of the embryos obtained was similar in both groups.
- The time required to obtain a chromosomally normal embryo was significantly shorter in the DuoStim group.
- Reducing the treatment timeline had a positive impact on overall success rates and significantly lowered the risk of treatment discontinuation.
The Emotional Benefits of DuoStim
Beyond its clinical advantages, the DuoStim protocol also provides important emotional benefits:
- It shortens the overall duration of treatment, helping to reduce accumulated stress.
- It increases the feeling of making progress by allowing more eggs to be retrieved within a single menstrual cycle.
- It reduces frustration, particularly in women who have experienced previous unsuccessful fertility treatments.
- It improves treatment adherence, lowering the likelihood of patients abandoning their fertility journey.
In a context where many couples discontinue fertility treatment before achieving parenthood, strategies such as DuoStim can make a meaningful difference by improving emotional resilience and encouraging patients to continue treatment.
References
Vaiarelli A, Cimadomo D, Petriglia C, et al. DuoStim: a reproducible strategy to obtain more oocytes and competent embryos in a short timeframe aimed at fertility preservation and IVF purposes. Upsala Journal of Medical Sciences. 2020;125(2):121–130.
Cerrillo M, Cecchino GN, Toribio M, et al. A randomized, non-inferiority trial on the DuoStim strategy in PGT-A cycles. Reproductive BioMedicine Online. 2022;46(4):536–540.
Vaiarelli A, Cimadomo D, Cerrillo M, Ubaldi FM, García Velasco JA. Surfing follicular waves in ovarian stimulation: Is there a role for LH in DuoStim protocols? Reproductive Biology and Endocrinology. 2025;23(Suppl 1):28.
