What does recent evidence say about DuoStim in poor ovarian responders?

ESHRE (2026) supports double stimulation in defined circumstances. Double stimulation can be used with the intention of accumulating oocytes or embryos when a fresh transfer is not planned (strong recommendation, updated on Cerrillo 2023 and Massin 2023). Double stimulation can be considered for urgent fertility preservation cycles (good practice point) — where the time available before gonadotoxic treatment is the constraint. Related recommendations on non-conventional starts: Random-start stimulation could be used where a fresh transfer is not intended, though the risk of OHSS in the event of concurrent spontaneous conception should be discussed with the patient (GPP). Luteal-start stimulation could be used where a fresh transfer is not intended and natural conception is not possible (conditional). Late luteal phase start with fresh transfer is probably not recommended for low responders (conditional). The consistent thread is that these approaches belong in freeze-all pathways. The evidence does not support them where a fresh transfer is planned. Note the guideline group's framing throughout: DuoStim is positioned as a way to accumulate material within a shorter interval, not as a method that improves per-oocyte quality.