CONTROLLED OVARIAN HYPERSTIMULATION
A woman’s eggs develop inside fluid-filled follicles inside the ovaries. During a natural menstrual cycle in which no fertility drugs are taken, several follicles begin to grow around day 2 -3 of the menstrual cycle, however over the course of the next few weeks, only one or at most two of these eggs develops to maturity, at which time the follicle ruptures, and egg is released during the process of ovulation. The other follicles that had begun to develop stop growing and becomes atretic (degenerate). Therefore, only a small percentage of eggs present in the ovaries are ever reached to have the potential for fertilization and pregnancy during the woman’s reproductive life span.
In the IVF process, we typically try to obtain as more mature eggs as possible since even in the best of circumstances, not every egg fertilizes, results in an embryo that develops appropriately and is genetically normal. A variety of fertility drugs, which contain FSH (follicle stimulating hormone) and LH (luteinizing hormone) are administered to the female partner. This is the same hormone that is produced by the pituitary gland to develop one egg. This allows several follicles to grow at approximately the same rate allowing us to collect more than one mature egg.
Conceive IVF has developed a variety of protocols that are tailored to each patient and will be provided by your doctor after a thorough evaluation has been completed. Important characteristics that are taken into account includes age, past history, ovarian reserve testing (FSH, estradiol, AMH levels), and antral follicle count.
Priming or preparation
A variety of medications are given in the weeks before stimulation of the ovaries starts. These are designed to improve ovarian response and to create more symmetrical growth of the follicles. This may include oral contraceptives or oral estrogens or oral progesterone’s and occasionally testosterone as will be indicated by the specific protocol determined by your Doctor.
These are a variety of medications that stimulate the growth of the resting follicles and represent higher levels of the hormones FSH and possibly LH (luteinizing hormone) which allow more than one egg to develop. Initial doses are individualized to each patient and doses are adjusted based on the hormone levels and ultrasound examinations which reflect the growth of the follicles. The avrege duration of these medications goes from 9-12 days.
Once the follicles have grown sufficiently, estradiol levels have risen, and the oocytes are felt to be mature, ovulation is triggered by one of the two ways. One approach is to be administered a shot of hCG (human chorionic gonadotropin). This is the hormone of pregnancy, but has a lot in common structurally with the hormone LH and, therefore, can induce ovulation. A second approach is to actually give LH to patient. This induces ovulation 36-44 hours after administration. Therefore, the oocyte aspiration (egg retrieval) procedure is usually scheduled 35 hours after these medications are given.