The role of Duostim in the treatment of low prognosis women: who and how?

Carlo Alviggi's lecture addresses how to secure an adequate number of oocytes and embryos in low-prognosis patients, for whom a single conventional stimulation cycle often ends with only a few or immature cells. The focus is the low-prognosis category, as defined in part by the POSEIDON criteria, where the limiting factor is not only ovarian reserve but also the time available to the couple.

The central idea is the DuoStim concept, that is, a double stimulation performed within a single menstrual cycle. Stimulation and retrieval in the follicular phase are followed by a second stimulation started in the luteal phase, with a further follicular aspiration. This approach makes it possible to collect more mature oocytes in a short period without postponing treatment to subsequent menstrual cycles.

The biological rationale rests on the theory of multiple follicular waves: within a single cycle antral follicles are recruited not once but in several waves. This means that the cohort of follicles available in the luteal phase can respond to gonadotropins and yield additional mature oocytes comparable in potential to those obtained in the follicular phase.

Particular attention is given to candidate selection. The principal recipients of DuoStim are women of advanced reproductive age and low-prognosis patients, for whom every lost week reduces the chances of success. The strategy is oriented toward the accumulation of oocytes and embryos, which is especially relevant before preimplantation genetic testing or when at least one euploid embryo is required.

The who and how section translates the concept into practical selection and planning criteria. The speaker examines which patients benefit most, how to schedule the second stimulation, how to monitor the response, and how to minimise the burden on the patient. It is stressed that DuoStim does not replace personalisation but is a tool applied on indication rather than to every patient.