Evaluating the impact of repeated ovarian stimulation cycles on follicle development in patients with suboptimal...

To assess if repeat ovarian stimulation improves follicle development after a canceled suboptimal cycle.

This retrospective cohort study included 162 patients who underwent two consecutive ovarian stimulation cycles between March 2018 and February 2024, with their initial cycle canceled due to the development of three or fewer follicles ≥14 mm. The primary outcome was the number of follicles ≥14 mm before ovulation triggering.

The mean age was 36.9 years during the first cycle and 37.2 years during the second. The median antral follicle count (AFC) was 9.5, and the mean anti-Müllerian hormone (AMH) level was 1.4 ng/mL. Compared with the first cycle, the second cycle showed increased mean daily follicle-stimulating hormone dose (from 352.4 to 401.2 IU, P < 0.001), stimulation duration (from 8.9 to 10.3 days, P < 0.001), peak estradiol (from 1927.7 to 3976.5 pg/mL, P < 0.001), and endometrial thickness (from 8.8 to 9.4 mm, P = 0.035). The mean number of follicles ≥14 mm increased from 1.5 to 4.2 (P < 0.001), with 125 of 162 (77.2%) cycles showing improvement. Protocol changes occurred in 90/162 (55.6%) cycles and there was a higher dose in 44/162 (27.1%). The mean increase in follicles ≥14 mm was 1.96 (95% confidence interval [CI] 0.92-3.00) with the same protocol and dose, 3.70 (95% CI 2.24-5.15) with a higher dose, and 2.40 (95% CI 1.76-3.03) with protocol change. Patients with AMH <1 ng/mL or AFC <7 were less likely to improve.

Most patients with an initial suboptimal response showed improved follicle development in subsequent cycles, particularly with protocol modifications or increased gonadotropin dosage. Patients with diminished ovarian reserve were less likely to improve and some experienced worse outcomes.