A multi-cycle approach via DuoStim is beneficial to treat couples indicated to PGT-M plus PGT-A. A propensity score matching-based case series

Abstract

Objective

To compare DuoStim versus a conventional approach in patients indicated to Preimplantation-Genetic-Testing for both monogenic conditions and aneuploidies (PGT-M + PGT-A).

Study design

Retrospective case-control study. In 5 years, 132 couples indicated to PGT-M + PGT-A who obtained ≤5 blastocysts after a first retrieval were suggested to undergo a second stimulation in the same ovarian cycle. Of them, 55 accepted, while 77 preferred the standard approach. Propensity-Score-Matching method was adopted to produce two matched groups of 41 patients per arm. The primary outcome was the cumulative-live-birth-rate (cLBR) per couple within 1 year from the first oocyte retrieval.

Results

In the DuoStim arm, 100 % of the patients underwent two ovarian stimulations. In the conventional approach group, 85 % discontinued the treatment after a failed first cycle (N = 28/33, 95 %CI:69.1–93.4 %). After DuoStim, 16 couples had ≥ 1 healthy LB (1-year cLBR: 39 %, 95 %CI:25.7–54.3 %), 19 % of them delivered 2 healthy babies after singleton pregnancies (N = 3/16, 95 %CI:6.6–43 %) and 68 % have surplus transferable blastocysts (N = 11/16, 95 %CI:44.4–85.8 %). In the control, 9 couples obtained a healthy LB (1-year cLBR: 22 %, 95 %CI:12.0–36.7 %), and only 1 have surplus transferable blastocysts. Overall, couples opting for DuoStim obtained 3.9 ± 2.5 blastocysts of which 1.2 ± 1.3 transferable, while couples opting for the conventional approach obtained 2.3 ± 2.1 blastocysts of which 0.8 ± 1.0 transferable.

Conclusions

DuoStim may minimize treatment discontinuation and increase the probability to obtain transferable blastocysts in the studied population. Nevertheless, larger prospective studies are required. Also, the suitability of a threshold set at 5 blastocysts should be further validated.