Dual Stimulation and Egg Accumulation for Low Ovarian Reserve
For women with low ovarian reserve, our aim is usually to maximise the number of eggs
collected rather than relying on a single stimulation cycle. Many such patients at
Jananam undergo more than one stimulation, and we frequently use dual stimulation when it is
clinically appropriate.
What dual stimulation is
Dual stimulation involves performing one ovarian stimulation from the beginning of the
menstrual cycle, followed by a second stimulation a few days after the first egg
retrieval — within the same menstrual cycle.
This allows us to collect more eggs within a shorter period of time than waiting for a fresh
cycle to begin each time.
Why the number of eggs matters so much in low reserve
Every retrieved egg will not necessarily be mature. Every mature egg will not fertilise.
Every fertilised egg will not become a blastocyst. And every blastocyst will not be
chromosomally normal.
Embryo development also depends on sperm quality and laboratory conditions. Each of these
steps reduces the number carried forward, which is why the count at the start matters.
For younger women, fewer eggs may be required to achieve a reasonable cumulative chance of
pregnancy. Women of increasing age generally need a larger number of eggs to reach the same
position.
Egg accumulation rather than higher doses
In diminished ovarian reserve, our strategy is often egg accumulation and
individualised stimulation, rather than simply increasing medication doses.
Raising the dose in a patient whose ovaries have limited reserve does not reliably produce
more eggs, and it increases the burden of the cycle. Collecting across more than one
stimulation, and freezing what is collected, is often the more productive approach.
Where time fits in
When ovarian reserve is reduced, we may recommend moving to IVF sooner, irrespective of age,
because time becomes an important factor. Reserve does not improve with waiting.
This is one of the reasons we discuss ovarian reserve results carefully at the first visit
rather than after several unsuccessful cycles of something less likely to work.
Common questions
What is dual stimulation in IVF?
Dual stimulation means performing one ovarian stimulation from the beginning of the menstrual cycle, followed by a second stimulation a few days after the first egg retrieval, within the same menstrual cycle. It allows us to collect more eggs within a shorter period of time than waiting for a fresh cycle to begin each time.
Who is dual stimulation suitable for?
It is used mainly for women with low or diminished ovarian reserve, where the aim is to maximise the number of eggs collected rather than relying on a single stimulation cycle. Many such patients at Jananam undergo more than one stimulation. Whether it is appropriate depends on the individual response, and it is not required for every patient with reduced reserve.
Does a higher medication dose produce more eggs in low ovarian reserve?
Not reliably. Raising the dose in ovaries that have limited reserve does not dependably produce more eggs, and it increases the burden of the cycle. In diminished ovarian reserve our strategy is egg accumulation and individualised stimulation rather than simply increasing medication doses, collecting across more than one stimulation and freezing what is collected.
How soon should IVF be considered when ovarian reserve is low?
Sooner than age alone would suggest. When ovarian reserve is reduced we may recommend moving to IVF irrespective of age, because time becomes an important factor and reserve does not improve with waiting. This is why we discuss ovarian reserve results carefully at the first visit rather than after several unsuccessful cycles of something less likely to work.
Written and medically reviewed by Dr. Vani Sundarapandian, MD, DGO, FRCOG (UK) —
founder and Medical Director, Jananam Fertility Centre, Chennai. Low ovarian reserve is one
of her stated clinical special interests.
