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The Shanghai double stimulation protocol is a specialized ovarian stimulation regimen developed for women with poor ovarian response (POR) undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Evaluated by the Royan Institute, the protocol involves two phases of stimulation within a single menstrual cycle: one during the follicular phase and another during the luteal phase. The treatment utilizes a combination of medications including clomiphene citrate and letrozole to induce ovulation, human menopausal gonadotropin (HMG) to promote follicle development, medroxyprogesterone acetate (MPA) to prevent premature luteinizing hormone (LH) surges during the second phase, and a GnRH agonist (triptorelin) to trigger final oocyte maturation. This approach is designed to increase the total number of oocytes retrieved and embryos available for transfer in patients who typically yield few oocytes with standard protocols.
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