BACKGROUND

Managing low ovarian response remains challenging despite advancements in assisted reproductive technology (ART). Although several approaches have been proposed, there is no strong evidence that a particular stimulation protocol is superior over the other in terms of improving reproductive outcomes in this group of women. The double stimulation protocol (DuoStim) suggests ovarian stimulation during both the follicular phase and the luteal phase of the same ovarian cycle; hence, facilitating two oocyte retrievals in the shortest amount of time.

OBJECTIVE

This study assessed the effect of the double stimulation protocol (DuoStim) on poor ovarian responders in terms of cumulative live birth rates and clinical pregnancy rates, and compared these outcomes to conventional stimulation protocols.

METHODS

This is a systematic review and meta-analysis of randomized controlled trials (RCT), cohort and cross-sectional studies in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Data from eligible journals were tabulated and analyzed using Cochran’s Q and I² tests.

RESULTS

Eight studies involving poor ovarian responders were included in the meta-analysis. Pooled analysis demonstrated no significant difference between DuoStim and conventional ovarian stimulation protocols in clinical pregnancy rate (OR 0.99, 95% CI 0.75–1.30) and cumulative live birth rate (OR 0.87, 95% CI 0.59–1.28). Fertilization rates were likewise comparable between groups. Nevertheless, several included studies reported higher oocyte yield and greater numbers of mature oocytes and blastocysts with DuoStim

CONCLUSION

Current evidence does not demonstrate significant superiority of DuoStim over conventional ovarian stimulation protocols in terms of clinical pregnancy rates, cumulative live birth rates, or fertilization rates among poor ovarian responders. However, DuoStim appears to be an effective strategy for increasing oocyte yield within a shorter treatment timeframe. Its use may be particularly relevant in selected patients with diminished ovarian reserve, advanced maternal age, or urgent fertility preservation needs. Further high-quality prospective trials are warranted to clarify its impact on reproductive outcomes.

Human ; Ovulation Induction ; Ovarian Stimulation ; Ovarian Reserve ; Fertilization In Vitro

Vulvar intraepithelial neoplasia (VIN) is a precancerous lesion involving the squamous epithelium of the vulva. This retrospective descriptive study aims to determine the prevalence of VIN in a tertiary government hospital in a developing country. Medical records of outpatient consultations with the diagnosis of VIN from January 2000 to June 2012 were reviewed. The prevalence of VIN was 1.6/100,000 women over the 12 years. The diagnosis was based on biopsy results of an incidental finding of vulvar lesions on physical examination. The profile of a patient with VIN was a woman aged 40 years old and above, married, multigravid, nonsmoker, high school graduate, and unemployed. Vulvar lesions noted were multiple hyperpigmented papules located at the posterior labia majora. VIN was associated with abnormal colposcopy findings, and 40% were associated with concomitant cervical disease. Treatment was wide local excision. Prompt diagnosis and appropriate treatment of VIN aim to prevent its progression to vulvar carcinoma. Although vulvar carcinoma is a rare condition, there has been a notable rise in prevalence in recent years. Hence, gynecologists should be vigilant and have a high index of suspicion to detect the disease early in its course.
Vulvar Diseases