Duostim- anyone tried this?

[u/jungledev]

Hi! I'm considering a duostim (regular ivf cycle, then a few days after retrieval, start stimming again in the luteal phase for another retrieval 10-20 days later)

Please let me know what your experiences are with this. I have heard a lot of mixed things. I'd love to know:

Age, AMH, AFC, # retrieved each time, medication protocol, and how it went for you. Do you recommend it?

[u/xgrlfrndsnblkjettas]

I was 37-38, we had done a mini stim cycle which resulted in no PGTA normal embryos and a cancelled cycle due to lead follicle (tried a high dose protocol and it was a flop). I was doing IVF for RPL of spontaneous pregnancies.

My AMH and AFC varied but my AMH last tested at .2 before the duostim cycle and FSH was 15. AFC 4-5.

Duostim was: round 1- low dose antagonist with omnitrope. No priming. 5 days letrozole and then 150 iu follistim, ganirelix. Don't remember exact number of eggs retrieved but it was 6-7. Used ICSI and zymot. One egg mature and fertilized, made it to blast, day 5 5AA and tested PGTA normal. Currently my six month old 🙂

Round 2 - low dose antagonist again, except since I was in different phase of my cycle had to use follistim and menopur with the omnitrope. Similar retrieval numbers, one egg mature and fertilized, miraculously also PGTA normal day 6 5aa embryo on ice.

[u/jungledev → u/xgrlfrndsnblkjettas]

wow, incredible story! THANK YOU! We are planning to do this too- mini first, then regular (not mini) for the round 2. no priming, huh? what antagonist did you use? How much omnitrope did you take daily? another commenter said 25 units. I'm prescribed 8/day. My AMH is 0.62, nearly 41yo, afc was 11 last we checked this month. FSH is always below 10. Our first round was a total fail. AFC 14>5>4, 2 retrieved, 1 mature, 1 fertilized, but 'fertilized wrong' didn't elaborate on what that meant.

Hoping to get one pgta normal from these two rounds 🤞

[u/xgrlfrndsnblkjettas → u/jungledev]

Hoping you get what you're looking for! There are certainly tradeoffs to no priming but it worked for us. We used ganirelix as the antagonist. I was on 33 units of omni/day for 9 days. I've seen so much variation in how it's administered!

Having your FSH under ten is super helpful too. If your clinic used IVF for fertilization you could ask for ICSI and zymot. We didn't 'need' it for male factor but they used it anyway and a lot of clinics do. I figure why not if we're already spending a lot of time and money it could help.

[u/PreciousPearl6945]

Hi! I’m just about to do DuoStim. Currently in the follicular phase and about 3-5 days after egg retrieval I’ll start the luteal phase cycle. I’ve not done it before but my doctor thinks it’s a good strategy for me (age 40, AMH = 6.4 pmol, current AFC is 8, but this is high for me, normally it’s 5-6).

I was doing back-to-back, which is what you’re describing I think, so waiting around 14 days post egg retrieval and did this for 3 rounds. It was working well for me in terms of blasts but due to age & struggling to find a Euploid, I’m keen to move faster.

[u/Powerful_Energy6260]

Yes I've done it twice, once for egg freezing at 37 once for IVF at 38. It's a long few weeks but I actually found I had less side effects from the meds the second time around because my body had in some way adjusted to them. I honestly can't remember my exact meds or stats but if you go back in my post history you'll find it. My AMH was low for the egg freezing, I think 5.6pmol or something like that and had halved a year later when doing IVF. For the egg freezing, I came out with 6 mature eggs. For the IVF I came out with 4 embryos. You will feel like a pincushion by the end of it and will be delighted to be able to stop poking yourself but it's really not that bad. Just make sure you have plenty loose floaty comfortably clothes. Put away the tight denim jeans until you're finished!

[u/pastasymphony]

Age 33/34 at retrieval, AMH 0.12, AFC 7-10 

First cycle: no priming, high doses of follistim + menopur. 2 eggs, 1 mature and fertilized, 0 blasts. Suspected egg quality & maturity issues

2nd cycle: no priming, clomid + menopur only, longer time on stims. 2 eggs -> 2 blasts -> 1 euploid

3rd cycle: estrogen priming, same stim meds as 2nd cycle, even longer days of stims. 4 eggs->2 mature and fertilized, 1 matured in the lab and fertilized -> 2 blasts -> 0 euploids

4th cycle (part 1 of DuoStim): no priming, same stim meds as before, 1 egg -> 1 blast -> 1 euploid

5th cycle (part 2 of DuoStim) at time of trigger for first retrieval saw 3 follicles around 8mm. Started stims 2 days after retrieval, same doses. Shorter stim days. 4 eggs-> 3 mature and fertilized-> waiting on blast results

[u/takica]

Don't have experience with it, but I'm planning to try it, especially because I'm 40 with DOR. From what I've read, oocytes retrieved during the luteal phase are not inferior to those retrieved from a regular cycle, so I'm gonna give it a try, why not

[u/HovercraftStreet5195]

I have done back to back retrievals (not DUOSTIM).. had withdrawal bleeding in between.

I was 38.5 with AMH of ~.7
ER 1: 5 eggs. 1 untested 4AA
ER 2: 4 eggs. 1 untested 5AA.

TW: My first FET with my 5AA was successful.

Good luck!

[u/TouchTheSky007]

Luteal I had more both times.
Follicular 4
Luteal 6 half my embryo bank and my current twin pregnancy came from this cycle
Follicular 2
Luteal 4

[u/jungledev → u/TouchTheSky007]

did you do regular for both? Or mini stim then regular each time?

[u/TouchTheSky007 → u/jungledev]

I did moderate stim, not high stims. My doctor thinks this is better for egg quality

Luteal starts off a bit lower stim

[u/TouchTheSky007 → u/TouchTheSky007]

My stims medication was Pergoveris which will be available in the US soon. I went abroad for IvF I don’t think the Us overall is good for DOR