The latest marketing fad in IVF is called Duostim. What is it? Who might benefit from
Duostim? Most importantly, what does the data say? Stay tuned and I will explain.
The key to successful IVF is the ability to mature and retrieve
multiple eggs from the ovaries. This is done using fertility medications of various types.
For a variety of reasons, some people respond to these medications better than others.
Watch this video for more information about the reasons this happens.
One of the more frustrating groups that fertility doctors encounter are people who do not respond
to fertility medications very well. These people, known as poor responders, are more likely to have
their IVF attempt canceled before reaching egg retrieval. When eggs are retrieved, they don’t get
as many eggs. Less eggs means less embryos. Less embryos means less opportunities to find healthy
viable embryos. This is part of the reason why pregnancy rates in this group are so low.
Over the years, there have been a number of different protocols offered for people who are
poor responders. You have probably heard of some of these. The two important things to
remember about all of these protocols is that none of them work very effectively
and none of them have ever been shown to work any better than any other protocol.
As a result, doctors and scientists are always l--ooking for new protocols to
help this group of patients. Poor responder IVF patients are desperate to have a child
and will believe anything that anybody tells them might be better.
Into this perfect storm of desperation comes Duostim.
Traditionally, doctors would start fertility medications within a few days of when a period
begins. This was based on how eggs mature naturally. Several years ago, however, doctors
in Japan found that you could start fertility medications at other times of the cycle, such as
after ovulation and there would still be immature eggs that would respond to the medications.
This discovery was very welcome for cancer patients who wanted to complete an egg retrieval
for fertility preservation. Speed is so important for this group of patients. Their oncologists were
anxious to have them start their cancer treatment. Waiting for their period to come to start
fertility medications could cause delays of weeks. Now, fertility specialists could start their
fertility medication at other times of the cycle. This is now known as a “random” cycle start.
Conclusion number 1. It is possible to mature eggs by starting fertility
medications at a non traditional time
People that are doing an egg retrieval for fertility preservation would also like to
have as many eggs as possible but, as I said before, they are short on time. Some doctors tried
something new. They would stimulate the ovaries once in the usual way but then, several days after
the egg retrieval, they would start stimulating the ovaries again. Guess what? It worked. They
were able to get more eggs in a shorter amount of time by doing two egg retrievals closer together.
Conclusion number 2. Duostim appears to be a reasonable option for cancer patients who
want to complete multiple attempts of fertility preservation rapidly before starting chemotherapy.
Next, some doctors tried using Duostim for people that were poor responders.
A number of claims started popping up on websites and social media claiming that Duostim was a
“better” protocol for poor responders that would produce “more eggs” of “better quality” and thus
result in more pregnancies. None of these claims are currently supported by the data.
Let’s look at the “more eggs” claim. Small studies claiming this benefit would analyze the number of
eggs obtained after two egg retrievals using duostim compared with one egg retrieval. Can
you get more eggs from two egg retrievals compared to one? Yes. Would it be the same if you performed
two egg retrievals in the traditional way compared to using Duostim? Most likely. Importantly,
none of the proponents of Duostim have ever published results of studies showing
two retrievals using Duostim produced more eggs than two retrievals done with traditional timing.
In fact, when you look at all of the Duostim studies, there is no evidence
that poor responding patients respond any better with duostim than other protocols. There is no
evidence that the quality of the eggs is any better or that more pregnancies will result.
Our InfertilityTV Bottom line is this. If you are in desperate need to complete two egg retrievals
in a shorter period of time, such as a cancer patient who needs to start chemotherapy, Duostim
is a reasonable option to discuss with your doctor. If you are a poor responding IVF patient,
attempting more egg retrievals to get more eggs and more embryos is a reasonable goal.
However, there is currently no data that suggests that duostim
is a better option for doing this compared to any other method.