“Egg-citing Times: Understanding Ovarian Stimulation for IVF"

 

At this point, you and your partner have both completed your fertility assessments, the physician has probably concluded by now that the infertility experienced is either due to the male partner or female partner or both or frustratingly, no known cause could be identified 😖😖😖

Now are you considering IVF treatment to start your family? If so, you have probably heard about ovarian stimulation, a crucial step in the IVF process that involves stimulating the ovaries to produce multiple eggs for fertilization. In this article, we will take look at how ovarian stimulation works in IVF and what you can expect during this initial phase of your fertility journey (this does not apply in situation of donor egg gamete).

So, what is ovarian stimulation? During IVF, the goal is to retrieve as many healthy eggs as possible from the ovaries. Ovarian stimulation is the process of using medications to encourage the ovaries to produce multiple mature eggs instead of the one egg that typically develops each month during a menstrual cycle in response to the natural hormonal signals. However, with extra hormonal medications, more eggs can develop from the group of follicles recruited for that month.

To begin the process of ovarian stimulation, the fertility doctor will extrapolate the best protocol and dose of drugs based on the female’s fertility evaluation, age, weight to create a personalized treatment plan for you.

The most common medication used for ovarian stimulation is follicle-stimulating hormone (FSH), which is similar to the natural hormone produced by the pituitary gland that stimulates the ovaries to produce eggs. Other medications, such as luteinizing hormone (LH) and human chorionic gonadotropin (hCG), may also be used to support ovarian stimulation and help with the final maturation and release of the eggs.

During ovarian stimulation, you will need to visit your fertility clinic regularly for monitoring. This typically involves blood tests and ultrasounds to track the growth and development of your ovarian follicles. The physician will use this information to adjust your medication dosage and determine the best time for egg retrieval.

The dynamics about ovarian stimulation protocol is that it is not one size fits all, it is tailored to your specific situation and fertility needs in order to optimize result, this is why it is extremely important to give the fertility doctor all the required information accurately.

Let us look at some peculiar situations and what to expect from ovarian stimulation;

1.      PCOS (Polycystic Ovarian Syndrome patients typically have higher levels of luteinizing hormone (LH) and androgens (male hormones) and lower levels of follicle-stimulating hormone (FSH), which can cause irregular ovulation and difficulty conceiving. To address these hormonal imbalances and improve the chances of successful IVF, the ideal ovarian stimulation protocol for PCOS patients should aim to increase the number of mature follicles while reducing the risk of ovarian hyperstimulation syndrome (OHSS). a moderate dose of FSH has been found to be the most effective in achieving good-quality embryos. It's also important to note that PCOS patients may require a longer duration of ovarian stimulation than patients without PCOS. This is because the ovaries may be less responsive to the FSH medication, and it may take longer for the follicles to mature.

2.      Endometriosis: Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside of it, leading to painful periods, infertility, and other symptoms. The ideal protocol for endometriosis patients aims to improve the chances of successful IVF while minimizing the risk of ovarian hyperstimulation syndrome (OHSS) and worsening endometriosis symptoms. The most commonly used ovarian stimulation protocol for endometriosis patients is the gonadotropin-releasing hormone (GnRH) agonist protocol. This protocol involves the use of GnRH agonist medication to suppress the ovaries before ovarian stimulation begins. By suppressing the ovaries, the protocol aims to reduce the inflammation and pain associated with endometriosis and improve the quality of the eggs produced.

3.      Diminished ovarian reserve (DOR) is a condition in which a woman's ovaries have a lower quantity or quality of eggs than is expected for her age. The most commonly used ovarian stimulation protocol for DOR patients involves the use of a low dose of gonadotropin-releasing hormone (GnRH) agonist medication, which is used to "flare" the body's natural production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). A higher dose of follicle-stimulating hormone (FSH) is then used to further stimulate the ovaries. This aims to produce a larger number of good-quality eggs and increase the chances of a successful IVF cycle.

 

While ovarian stimulation is a crucial step in the IVF process, it's important to note that it involves some risks. The medications used for ovarian stimulation can cause side effects such as bloating, mood swings, and headaches. In rare cases, ovarian hyperstimulation syndrome (OHSS) can occur, which is a serious condition that can cause abdominal pain, nausea, and shortness of breath.

However, with proper monitoring and management by your fertility team, the risk of these complications can be minimized and avoided.

Once your ovarian follicles have reached the appropriate size, your doctor will schedule the egg retrieval procedure. This is typically performed under sedation or anesthesia and involves using a needle to aspirate the eggs from the follicles passing through the vagina (no open surgery, no scars!!!!).

The retrieved eggs are fertilized with sperm in the laboratory and monitored for development. The resulting embryos are then transferred to the uterus in hopes of achieving a successful pregnancy.

In summary, ovarian stimulation is a crucial step in the IVF process that involves using medications to stimulate the ovaries to produce multiple eggs for fertilization. While it carries some risks, the benefits of IVF and the ability to start or grow your family can far outweigh the potential complications.

If you're considering IVF, speak with your fertility doctor about the ovarian stimulation process and what you can expect during your journey. With the right support and guidance, you can navigate this exciting phase of your fertility journey with confidence and hope for a successful outcome.

@yourivfembryologist is a world renowned and certified Senior Clinical embryologist, highly skilled and experienced, widely travelled, internationally trained with over a decade of experience in the IVF lab. Knowledgeable in all aspects of reproductive science and genetics. A University College of London and University of Leeds Alumni. First-class and distinction degree holder. Passionate about spreading knowledge of IVF, ensure continuity of knowledge amongst embryologists and helping patients through the IVF journey.