Managing patients with Poor Ovarian Reserve (POR) remains one of the greatest challenges in assisted reproductive technology. Historically, individuals with low Anti-Müllerian Hormone (AMH) or low Antral Follicle Counts (AFC) faced repeated cycle cancellations or were routinely counselled toward donor eggs. However, modern reproductive biology introduces revolutionary strategies to optimize a patient’s own genetic material. According to Prof. (Dr.) Abha Majumdar, protocols like Dual Stimulation (DuoStim) change the treatment paradigm by maximizing egg collection within a single menstrual cycle. However , repeated consecutive cycle stimulations leading to embryo pooling has the advantage to have optimal numbers of embryos which give you the best strategy towards one live birth. In almost 25% of women the second child is also conceived with these frozen embryos after the first child is of manageable age.
To deliver precise treatment, our clinical team at Sir Ganga Ram Hospital categorizes patients using the internationally recognized POSEIDON criteria (Patient-Oriented Strategies Encompassing Individualized Oocyte Number). This framework shifts the focus from old, rigid definitions to a more practical, individualized approach.
First, we evaluate the patient’s age and specific ovarian biomarkers, including AMH and baseline follicle counts. Second, we analyse their past responses to standard ovarian stimulation. Consequently, this precise classification helps us identify “unexpected poor responders” versus patients with true, low biological reserves. By targeting the exact physiological root cause, we can significantly improve clinical outcomes for complex cases.
Professor’s Global Clinical Insight: Ovarian aging does not always follow chronological age. A young patient may exhibit a low AMH due to genetic factors or prior ovarian surgeries for example removal of an ovarian cyst or endometrioma. Therefore, it is mandatory to counsel the woman regarding the need for more than one ovarian stimulation cycle to collect enough embryos. For these one needs to customize the protocol, dosage and timing of gonadotropins to extract maximum quality from the remaining follicle pool.
The DuoStim protocol is built upon the scientific discovery that multiple waves of follicle growth occur within a single menstrual cycle. Traditional IVF stimulation targets only the first wave during the follicular phase. In contrast, DuoStim performs two sequential stimulations and two egg retrievals all within the span of about 28 to 30 days.
| Phase | Clinical Interventions | Expected Outcome |
|---|---|---|
| 1. Follicular Phase Stimulation | We initiate customized gonadotropin stimulation on Day 2 of the menstrual cycle. Once follicles mature, we perform the first egg retrieval (OPU 1). | Secures the first cohort of mature oocytes from the early natural wave. |
| 2. Inter-Phase Interval | The patient rests for approximately 4 to 5 days following the initial retrieval while our lab fertilizes and creates embryos. | Allows the hormonal environment to transition smoothly into the luteal phase. |
| 3. Luteal Phase Stimulation | We restart gonadotropin injections immediately, targeting the second wave of follicles. Once mature, we perform the second retrieval (OPU 2). | Collects a second cohort of oocytes, frequently yielding higher numbers and superior embryo quality. |
Furthermore, because we collect eggs in two consecutive phases, we freeze all resulting embryos via advanced vitrification. We completely avoid fresh embryo transfers during a DuoStim cycle. This delay ensures the uterine lining returns to a perfectly receptive, natural state before we attempt an embryo transfer.
For international patients with limited time frame, and individuals racing against an aging biological clock, the DuoStim protocol delivers clear, evidence-based benefits:
Beyond Dual Stimulation or multiple stimulation cycles, Dr. Abha Majumdar integrates specific, scientifically validated adjuvants to naturally enhance ovarian responsiveness and egg quality: androgen priming and addition of LH with pure FSH injectables in ovarian stimulation.
Ultimately, a diagnosis of poor ovarian reserve or low AMH is not an absolute barrier to biological parenthood. By combining structural classification via the POSEIDON criteria with cutting-edge protocols like Duo Stim, Bi Stim our center provides couples with the highest global standards of reproductive care. We focus entirely on clinical excellence to help you achieve a successful pregnancy with your own eggs safely and predictably.
