ArticleFrontiers in endocrinology2026
Ten years of DuoStim in time-sensitive poor-prognosis IVF patients: real world cumulative outcomes and treatment trajectories.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: To evaluate DuoStim strategy across a decade from its clinical implementation in IVF by comparing embryological and clinical outcomes between the first and second ovarian stimulations (1st-OS and 2nd-OS) conducted within 30 days, focusing on treatment efficiency and time-to-conclusion. Methods: Retrospective single-center study (2015-2024) including 1656 poor-prognosis patients undergoing 1896 DuoStim cycles planned for ICSI and PGT-A at the blastocyst stage. Poor prognosis was defined as very advanced maternal age (≥40 years) and/or reduced ovarian reserve (AMH ≤1.2 ng/mL, AFC ≤5, or ≤3 oocytes in previous retrievals). Endpoints included all embryological, clinical and neonatal outcomes comparing 2nd-OS versus 1st-OS and cumulatively. Among 1561 concluded first DuoStim cycles, we calculated time-to-treatment-conclusion (TTC), stratified as without a live-birth (TTC-noLB) and with a live-birth (TTC-LB), and treatment discontinuation at our center after a first failed DuoStim attempt. Results: The use of DuoStim increased over time, reaching 34% of all cycles in 2024. The 2nd-OS yielded more oocytes and embryos than 1st-OS, while their competence was comparable. Consequently, the 2nd retrieval provided a cumulative incremental yield of 66% for cycles achieving ≥1 euploid blastocyst and 125% for cycles achieving ≥1 live birth (LB) compared with the 1st-OS alone. Median TTC was 40 days (quartile-1: 36, quartile-3: 118.5), while TTC-noLB and TTC-LB were 38 days (quartile-1: 35, quartile-3: 41.5) and 145 days (quartile-1: 112.25, quartile-3: 221), respectively. Embryological and clinical outcomes were stable across the years. Treatment discontinuation among patients without a LB after a first completed DuoStim decreased from 61% in 2015 to 44% in 2021, as second DuoStim attempts increased from 16% to 21% and transition to egg donation from 9% to 21%. Conclusion: DuoStim is a multicycle stimulation strategy that represents an alternative approach for patients requiring multiple treatment opportunities within a short timeframe. It shifts IVF toward a flexible personalized journey for poor prognosis patients. By enabling two stimulations within a single ovarian cycle, it achieved a cumulative live birth rate of 28.5% per concluded cycle in our cohort, within a consistently short timeframe in terms of both TTC-noLB and TTC-LB. Overall, DuoStim represents a treatment strategy that supports rapid and effective clinical decision-making in time-sensitive patients.
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