reproductive medicine

Stimulation

Ovarian stimulation (or, more precisely, controlled ovarian hyperstimulation) aims to simultaneously grow a larger number of egg follicles by administering various medications.

Stimulation is done following predefined patterns, called stimulation protocols.

Which protocol will be the choice of your fertility consultant, and how exactly it will be done depends on the specifics of your case. Factors to consider are the ovarian reserve status, age, ovarian response to previous stimulation, concomitant diseases etc.

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Everything about stimulation

Each woman responds in a different way to the different stimulation medications. Because of this, the personalised approach in the choice of protocol and the close monitoring of stimulation response are mandatory.

The first three to five days after the start of stimulation, you will have injections assigned without a scan. After this, your visits to your doctor will be every other day to monitor your response to stimulation. He will check your hormone levels and do an ultrasound scan to determine the number and size of growing follicles and the uterine lining thickness.

Our medical team can fine-tune the stimulation by changing the medications used or their dosing depending on your results. In some cases (poor ovarian response, adverse events, etc.), it can be aborted at the discretion of your fertility consultant.

The stimulation medications are applied by subcutaneous injection, daily for 10 to 14 days.

The manipulations office of ‘Nadezhda’ IVF centre has preset office hours for the applications of stimulation medication. Please inform yourself about them and plan your visit to the hospital when most convenient for you. There is no need to book an appointment.

Many patients prefer to apply the subcutaneous injections themselves. If you choose to save time and skip the daily visit to the hospital, our midwives will give you detailed instructions on the proper way to do the injections.

If you have any questions or doubts about this stage of the IVF cycle, please promptly contact us.

In natural cycle IVF, no stimulation medication is used. Most often, a single follicle is monitored to retrieve one oocyte. An ovulation trigger injection is applied between the 34th and 37th hour before egg retrieval. In some cases, at the discretion of your fertility consultant, a short medication course may be added to support follicle development.

 

NB! In contrast to stimulated cycles, where at least three months have to pass before a new attempt, natural cycle IVF can be repeated every month. Another advantage is undergoing egg retrieval without anaesthesia if you prefer.

 

If you are undergoing a natural cycle IVF without any stimulation, you have to book an appointment with your fertility consultant about day 9 or 10 of your menstrual cycle. If a light stimulation is planned, your procedure will start on day two or three.

The approximate duration of monitoring in natural cycle IVF is about ten to twelve days. During that time, you will have blood hormone tests and ultrasound scans to check the development of the dominant follicles. Please keep in mind that it takes about two hours for blood tests to be ready. We advise you to plan your visit to ‘Nadezhda’ in such a way that by the time of your appointment with the doctor, your blood work is ready.

Your stimulation progress will be closely followed up until enough follicles have matured. Then a new medication will be administered that supports the final maturation of the oocytes. The injection is applied subcutaneously at a strictly determined time, usually about 34 to 37 hours before the planned time of egg retrieval.

NB! In an IVF cycle, it is crucial that the eggs are retrieved before spontaneous ovulation occurs. That is why you must strictly observe the time for administration of the final injection (30 minutes delay usually is not fatal, but an hour and a half is). Typically the trigger shot is applied precisely 36 hours before oocyte retrieval. No matter the hour, you will always find a midwife or a nurse at the hospital to assist you in this final step.

From this point onwards, all stimulation medication is discontinued.

See also

Preparing for IVF
Egg retrieval
Embryo culture
Embryo transfer and pregnancy test
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