Ovarian stimulation: process, medications and symptoms

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Ovarian stimulation is the first step to be able to make a treatment of artificial insemination, in vitro fertilization (IVF) or ICSI with own eggs, as well as to freeze ovules to preserve fertility and to donate ovules. For this, hormones are administered in controlled doses, which will start the maturation of the ovules in the ovary of the woman.

The purpose of ovulation stimulation is to achieve the maturation of several follicles at once to increase the number of oocytes obtained in the ovarian puncture and, therefore, increase the number of embryos and thus the possibility of achieving pregnancy.

Below you have an index with all the points that we will discuss in this article.

Index

Ovarian stimulation: process, medications and symptoms

Hormone medication to stimulate ovulation

In each menstrual cycle, a group of ovules (cohort) begins its maturation, but finally only one of them manages to fully mature. The rest ends up degenerating.

So that in the ovary the total maturation of several ovules takes place at the same time it is essential to inject a specific medication during a period of time.

With this medication, the ovary is stimulated to try that all those ovules that begin to mature in that cycle get it and do not degenerate. These medications are hormones that control the development of ovules in the ovary: gonadotropins and agonists or antagonists of GnRH.

The gonadotropins are responsible for controlling the menstrual cycle of women:

  • FSH (follicle stimulating hormone): it induces the maturation of the follicles where the ovules in the ovary are developing.
  • LH (luteinizing hormone): can be used in a complementary way to FSH to try to reproduce the conditions of the natural menstrual cycle.
  • hCG (human chorionic gonadotropin): injected 32-36 hours before the follicular puncture. This hormone induces ovulation approximately 36 hours after its administration, so it is necessary to collect the ovary from the ovary before they are released naturally to the fallopian tube, that is, before ovulation takes place.

The GnRH agonists and antagonists are homologs of the hormone GnRH that the brain naturally produces to control the secretion of hormones. Both medications are used to decrease the brain control of ovarian development and thus be able to better control the time of ovulation.

  • GnRh agonists: control the maturation of the ovules so that it occurs at the same rate in all the ovules. Thus, there will be no more mature than others.
  • GnRh antagonists: they are the most used because they present more advantages than agonists. The woman tends to tolerate them well and the stimulation is not aggressive.

There are several methods or protocols for the administration of hormones in ovarian stimulation. Currently two are used: the long protocol with agonists and the short with antagonists, which differ in duration and number of injections to administer.

The doctor must decide which one to follow and the dose to be administered, adapting to the needs of the woman based on the results of her hormonal analyzes, the woman's age, the ovarian response in previous cycles, etc.

  • Short protocol: usually begins on the third day of menstruation (third day of the cycle) with injections of gonadotropins, either FSH alone or combined with LH, until the follicles mature. From day 8 of the cycle, about 5 days after starting the administration of gonadotropins, the antagonist is administered to avoid the peak of LH that would trigger ovulation. When follicles are mature, hCG is administered to cause ovulation 36 hours later.
  • Long protocol: in the previous menstrual cycle, on day 21 of the cycle, the administration of a GnRH agonist is started until menstruation arrives 10-14 days later. This prevents spontaneous ovulation. Next, gonadotropins, either FSH alone or in combination with LH, are administered until a follicle size and adequate estradiol levels are observed to indicate their maturity. Once the follicles mature, hCG is administered to cause final maturation and ovulation 36 hours later.

In both cases, the follicular puncture to collect the ovules will be done before ovulation occurs.

In a short stimulation protocol, the duration is about 15-17 days, while with a long protocol it is necessary to add 10-15 days of previous preparation.



Step by step ovarian stimulation

Medication for ovarian stimulation should be administered by injections subcutaneously into the abdomen. There is no format in pills. The patient should do it as taught by the doctor or nurse at the fertility center, taking care not to inject a smaller dose or do it incorrectly.

If there is any doubt in your administration, it is recommended to consult with the doctor, because if it is not done correctly, the desired ovarian response may not be obtained and the cycle may have to be canceled.

Usually the injections should start with the lowering of the rule, that is, the first day of the menstrual cycle, but it will depend on the stimulation protocol that will be followed.

With this medication, which the patient must inject daily during the stipulated time, the follicles that begin the maturation will continue to develop until they reach full maturity, at which time they will be collected.



Medical monitoring

The use of medications for stimulation requires an exhaustive follow-up and control by the gynecologist. For this, it is necessary to perform estradiol hormonal analyzes to see that the response of the ovary is adequate and that the follicles are maturing and growing well.

Through periodic transvaginal ultrasound you can see the number of follicles that are maturing and their size. Thus, if they are developing properly, the date of the ovarian puncture can be programmed to recover the ovules when the follicles reach 18 mm.

Follicular stimulation tracking

In order for embryos to implant after embryo transfer, it is also essential to monitor the growth of the endometrium during the administration of the medication used during the stimulation. If the endometrial thickness is not adequate, implantation can not occur.



Ovary response to medication

The ovary can respond in various ways to the medication of ovarian stimulation, so that the results of the stimulation process can be different depending on the medication used and the patient.

A low response can occur, so that a low number of follicles mature and few oocytes are recovered in the ovarian puncture. A low responder presents low levels of estradiol in periodic hormonal analyzes during the stimulation process.

In cases of low response it is also possible that the stimulation is unsuccessful and no oocyte is recovered at the puncture, either because the follicles are empty, either because the maturation of none is achieved or even because an adequate size of the follicles is not achieved. follicles (must reach 18 mm).

It is common for women over 35 years to have a low ovarian reserve and therefore also the response of their ovary. However, there are also cases of young women with low response due to early ovarian failure or premature ovarian failure.

The opposite can also happen, that the ovarian response is excessive. In this case, the ovarian hyperstimulation syndrome (OHSS) can occur, which can endanger the health of the patient.

To avoid the risks, when it is suspected that an ovarian hyperstimulation syndrome could occur, the cycle is canceled, so that the ovarian puncture is performed but the endometrium is not going to be prepared and the embryo transfer is not going to be carried out.

Symptoms and side effects

The hormones administered, as with any other type of medication, can cause side effects. Among the most common are bruises in the area of ??injection, abdominal swelling, temporary weight gain, heaviness in the legs, mood swings, pressure sensation in the ovaries and vaginal dryness.

These are symptoms similar to those that are usually experienced during menstruation and are usually mild discomforts.

However, if the response to medication is excessive, ovarian hyperstimulation syndrome (OHSS) may occur. The consequences in this case can be serious for the patient.

In the SHO the ovaries swell, which can cause ovarian pain, and the fluid can be poured into the pelvic cavity. This can have mild, moderate or severe effects, depending on the symptomatology that occurs. Moderate effects include severe headaches, swelling, vomiting, abdominal pain, severe cramping, and diarrhea. In severe cases there could be damage to the ovaries and difficulty breathing.

Questions from users

Does ovarian stimulation advance menopause?

No, the hormonal medication what it does is "rescue" those follicles that begin the maturation but were going to degenerate and die. In a natural cycle only one egg fully matures, but with the medication the objective is that all those who begin maturation finish it.

Are there natural products to do ovarian stimulation more naturally?

No, only a hormonal stimulation of ovulation and through injections is possible. There is no more natural method. The administration, although it is through a puncture, is simple and does not hurt.

What response is expected in ovarian stimulation at age 45?

It is common for women over 40 years to have a low ovarian reserve, so the ovary is expected to have a low response. Many of the women who want to have a child at these ages need ovodonation because they can not use their own eggs.

What is the price of the medication for ovarian stimulation? Does it cover social security?

In an artificial insemination, the medication used is softer and the dose is lower, so the price will be approximately ? 200-300. However, if the ova are to be removed from the ovary, as in IVF and ICSI, the required dose is higher and the medication must be stronger. The price of it is about 1,000-1,200 ?.

If the woman or couple meets the requirements to access the assisted reproduction treatments by the social security, the medication, like the rest of the treatment, will be free. If you can not access the treatments for public health, you must do the treatment in a private center and therefore the medication will not be financed by the social security; must pay its full cost.

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