Ovarian Stimulation
Treatment For Infertility

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What Is Ovarian Stimulation?
How Does It Work?
Minimal Stimulation: Clomid Alone
Aggressive Stimulation: Pills and Injections
What Are The Side Effects Of Ovarian Stimulation?

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Other names: Ovarian stimulation is also called ovulation induction.

What Is Ovarian Stimulation?

Ovarian stimulation is a term doctors use when talking about fertility treatments for women. It involves taking fertility drugs to stimulate the ovaries into producing more eggs than normal with the aim of increasing the chance of pregnancy. Ovulation is the release of an egg from the ovaries once a month as part of the natural menstrual cycle. If this egg encounters sperm on its passage through the fallopian tubes, pregnancy occurs. About 30 percent of women who suffer from infertility do so because of a problem with ovulation. Either there is an absence of ovulation (no egg is released) or there is poor-quality ovulation. Ovarian stimulation is the simplest treatment for this problem. It may be offered as a stand-alone treatment, or as part of assisted reproductive technology (ART) treatments like IVF.

How Does It Work?

There are several different types of drugs that can be used to stimulate the ovaries. Some regimes are simple and only require taking a pill for a few days- mild ovary stimulation in this manner is called minimal stimulation. Other medication regimes are more complex and involve both pills and daily injections. These are called names like the down regulation cycle, pill boost cycle and GNRH Antagonist cycle. While minimal stimulation has lower success rates than complex cycles, it is cheaper and involves taking fewer drugs.

Minimal Stimulation: Clomid Alone

This regime involves taking a medication in pill form called clomiphene citrate (brand names Clomid and Serophene). The medication is usually taken between days 2 and 6 of the menstrual cycle. The typical dose is 50mg a tablet, taken for 5 days. This is known as one cycle. If the cycle fails to produce a pregnancy after 3 months, the dose may be increased in increments of 50mg per subsequent cycle. Clomiphene, according to studies, increases ovulation in about 80 percent of women who take it. Roughly 50 percent of these will become pregnant during treatment. The medication works by tricking the body into thinking that estrogen levels are low. As a result the brain sends a signal to the pituitary gland to release more follicle stimulating hormone (FSH) and luteinizing hormone (LH) into the blood. High levels of these hormones stimulate the ovaries into releasing more eggs. Your doctor will track your cycle to spot when you have ovulated. Tracking methods include:

Basal body temperature (BBT) chart
Ovulation prediction kit
Blood tests
Ultrasound scan.

Once an egg(s) has been released, fertilization can occur through timed intercourse or artificial insemination. Your doctor will tell you which method is most likely to result in a baby. Other medications are sometimes combined with clomiphene to increase the chance of conception. Low doses of estrogen help to thin the cervical mucus, making it easier for sperm to enter the womb, or progesterone helps to maintain a thick womb lining so an embryo can implant.

Aggressive Stimulation: Pills and Injections

Down regulation cycle, pill boost cycle and GNRH Antagonist cycle.

If minimum stimulation fails to work, your fertility clinic will recommend aggressive stimulation. This treatment is usually necessary where egg retrieval for IVF or other ART treatments is planned. Why? Because it results in bigger multiples of eggs being released (8 to 10 or even more). At the time of ovulation, the eggs are extracted surgically. Any that are not used for the first cycle can be stored for future cycles. On average it takes 3 IVF cycles for a successful live birth. Deciding which cycle (down regulation, pill boost or GNRH antagonist) is used is crucial to a successful outcome and minimizes the risk of complications (primarily over-stimulation, known as hyperstimulation syndrome, OHSS). To do this your doctor will classify you as either a high responder or low responder. He will make this decision based on your age, ovarian reserve blood tests and by number of antral follicles.

What Are The Side Effects Of Ovarian Stimulation?

The main danger of ovulation induction is the over-stimulation of the ovaries leading to OHSS. Symptoms of OHSS usually appear 6 to 8 days after treatment is finished, if they are going to. Symptoms can range from mild to severe; it results in a hospital stay in about 1 percent of cases.

Symptoms Cause Of Symptoms Additional Notes
Mild Symptoms
Small weight gain
Ovaries larger than normal, fragile and tender.
High levels of estrogen and progesterone in the bloodstream can upset the digestive system, causing fluid retention and bloating.
Drink clear fluids, water, cranberry juice. Reduce physical activities like lifting and exercise.
Moderate Symptoms
Weight gain of more than 2 pounds a day.
Clothes feel tight and tummy bloated.
Vomiting and diarrhea.
Darker urine and less of it.
Skin and hair dry.
Extra thirsty.
High levels of hormones in the bloodstream cause digestive problems.
Dehydration in the rest of the body due to fluid retention in the abdomen (bloating).
Record your weight twice a day, and the number of times you urinate. Contact your doctor if you gain more than 5 pounds in 24 hours or urination frequency declines 50 percent or more.
Severe Symptoms
Bloating above the belly button.
Shortness of breath.
Urination has stopped and becomes darker.
Chest pain and calf pain.
Lower tummy pain.
Very over-enlarged ovaries.
Fluid collecting in the lungs, abdominal cavity and tissues.
Risk of blood clots increase.
You may need to be hospitalized. Excess fluid may need to be drained from your abdominal cavity.
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For more information, see the following:

How to prepare for IVF: Alternative therapies, sleep and diet.
Assisted hatching: Will it improve my IVF success rate?
Day 5 embryo transfer: Allowing your babies to grow!
Infertility guide: Causes, tests and treatments.

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