What you need to know:
- Ovarian stimulation is carried out to harvest as many mature eggs as possible to be fertilized using the IVF process.
- This procedure is performed with a combination of synthetic hormones and drugs to stimulate the ovaries.
Ovarian stimulation is the second stage (after examination) of the IVF program. This stage is carried out to produce as many mature egg cells as possible. One of these egg cells will be fertilized to be inserted back into the uterus with the ultimate goal of producing offspring.
Before ovarian stimulation
As a procedure, before ovarian stimulation is carried out you will carry out several types of examinations with the aim of finding out the condition of your body. The doctor will perform a series of tests such as:
Ovarian reserve testing
This test aims to evaluate the number of egg cells by examining levels of anti-mullerian hormone (AMH), follicle stimulating hormone (FSH), estradiol and ultrasound examination.
Sonohysterography (SIS) - Examination of the uterine wall
The following test is carried out by injecting saline or what is commonly used as an IV fluid into the uterus through the vagina, before being followed by an ultrasound to view the uterine cavity (sonohysterography).
Stages of ovarian stimulation
This procedure is carried out by administering synthetic hormones and drugs such as:
- Follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a mixture of both to stimulate the ovaries to increase the number of egg cells.
- Human chorionic gonadotropin (hCG), given 8-14 days after an injection of ovarian stimulating hormone to stimulate egg maturation and prevent ovulation or egg release.
- Ovulation suppressant medication to delay the release of an egg.
- The synthetic progesterone hormone will be given on the day of egg retrieval, to support the lining of the uterine wall for embryo attachment
The ovarian stimulation process will take approximately 2 weeks before the eggs can be retrieved. While this procedure is being carried out, you will also have to do regular transvaginal ultrasounds to ensure the growth of egg cells, as well as blood tests to determine hormone levels in the body.
As additional information, because this procedure takes quite a long time, you may need to inject the drug yourself at home
Ovarian stimulation can be repeated several times to obtain the desired results. The doctor can change the dose of hormones given to prevent low, too high cell growth or premature ovulation.
The next stage is egg retrieval. Ripe egg cells will be stored in an incubation container containing a special fluid to be fertilized by sperm. After obtaining sperm, the fertilization process will continue with the fusion process between sperm and ovum. This process is called insemination. If insemination is not possible, sperm will be injected into the egg using a microscopic needle. This process is called intracytoplasmic sperm injection (ICSI).
A successful fertilization process will produce an embryo whose development will be evaluated. Healthy embryos will be transferred into the uterus approximately 3-5 days after egg retrieval. An embryo is said to be successful if it survives 6 to 10 days after embryo transfer.
Side effects that can occur
According to the American Society for Reproductive Medicine (ASRM), the synthetic hormones used in this procedure have the potential to cause side effects such as:
- Fatigue.
- Breast pain
- Ovarian hyperstimulation syndrome (OHSS), which can cause swollen ovaries, stomach cramps, abdominal pain and bloating.
Source
American Society for Reproductive Medicine. (2016). Medications for Inducing Ovulation: A Guide for Patients . AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE. https://www.reproductivefacts.org/globalassets/_rf/news-and-publications/bookletsfact-sheets/english-pdf/booklet_medications_for_inducing_ovulation.pdf
ESHRE Reproductive Endocrinology Guideline Group. (2019). OVARIAN STIMULATION FOR IVF/ICSI . European Society of Human Reproduction and Embryology. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Ovarian-Stimulation-in-IVF-ICSI