The Shanghai Protocol 

(Double-stimulation/DuoStim) represents a paradigm shift in assisted reproductive technology, leveraging the physiological basis of multiple follicular waves to optimize oocyte yield in challenging patient populations. This comprehensive review synthesizes ten years of randomized controlled trials and meta-analyses evaluating double ovarian stimulation within a single menstrual cycle.

Clinical evidence demonstrates significant improvements in oocyte retrieval outcomes, with meta-analyses reporting mean differences of 3.35 additional metaphase II oocytes (95% CI 2.54–4.15, P<0.05) compared to conventional stimulation protocols. The protocol's efficacy is particularly pronounced in poor ovarian responders meeting Bologna criteria and oncologic patients requiring urgent fertility preservation.

By capitalizing on follicular wave theory and luteal phase progesterone-mediated LH suppression, this approach reduces treatment timelines by approximately 2.5 months while maintaining embryo quality. This evidence-based analysis explores the protocol's physiological mechanisms, clinical outcomes, safety profile, and future directions in reproductive medicine.