By Dr. Rut Gómez de Segura (Gynaecologist – Reg. No. 28/2908776).
Ovarian stimulation involves the administration of hormonal treatment to increase the number of eggs produced by a woman. This ovarian stimulation treatment is performed during fertility treatment or egg donation. It helps to increase the chances of pregnancy.
The goal of ovarian stimulation is to ensure that all follicles "recruited" in a natural cycle reach maturity instead of degrading. This allows summarizing in a single cycle what a woman would produce in a year. The treatment uses the same hormones produced by the woman, but in synthetic form.
Ovarian stimulation is performed in most fertility treatments, such as in vitro fertilization or artificial insemination (AI). In the case of egg donation, the process is performed on the donor. Additionally, ovarian stimulation is also an essential procedure before egg vitrification in fertility preservation treatments.
Ovarian stimulation must begin within the first 3 days of menstruation. It usually lasts between 10 and 14 days. The duration may vary depending on the protocol used and each patient's response to hormonal treatment. The time between 2 ovarian stimulations may vary depending on the case.
Here are the steps of ovarian stimulation:
The first step is to have an initial consultation with a fertility specialist, who will conduct a general medical examination. The expert will assess the patient's needs and recommend the most appropriate type of ovarian stimulation for fertility treatment. During this consultation, an initial baseline ultrasound will be performed.
We continue to provide follicle-stimulating hormone (FSH) to the body through subcutaneous injections. This allows other follicles (in addition to the dominant one) to continue maturing instead of degrading.
Selecting more than one follicle allows us to access a larger number of oocytes in a single cycle. Thus, we have more opportunities to perform in vitro fertilization and obtain more embryos that could lead to pregnancy.
Ovarian puncture allows for the recruitment of ovarian follicles that can potentially produce an egg during this cycle. If we started ovarian stimulation later, these follicles would begin to degrade and become useless. During this process, the fluid from the follicles is aspirated to obtain the eggs.
It is performed under anesthesia and is a short and painless procedure. The puncture is scheduled 34 to 36 hours after the final injection of human chorionic gonadotropin hormone (hCG).
The hormonal interaction between the hypothalamus, pituitary gland, and ovaries regulates the functioning of the ovarian system. This hormonal axis is activated with the onset of puberty. It is a communication system that regulates female menstrual cycles, and in which hormones are the language used.
The gonadotropin-releasing hormone (GnRH) is secreted by the hypothalamus. This hormone acts on the pituitary gland, signaling it that it is time to secrete two hormones, LH and FSH. The latter two cause ovulation and stimulate the secretion of sex hormones (estrogen and progesterone) by the ovaries.
The production of the follicle-stimulating hormone (FSH) begins with the onset of puberty. This hormone induces the growth of dormant or inactive ovarian follicles. Under normal conditions, although several follicles are recruited each menstrual cycle, only one of them will reach ovulation. This dominant follicle will release its egg, causing the degradation of the remaining follicles.
Every woman is born with a limited ovarian reserve, that is, a finite number of cells that will become eggs. It is not in the nature of the human body to expend more than necessary. Therefore, it is not normal for women to generate more than one egg per cycle. Thus, women who carry twins are truly unusual.
Ovulation is accompanied by the production of estrogen and progesterone. A high level of estrogen in the blood signals to the pituitary gland that it must slow down its production of FSH, as ovulation has already occurred.
At the same time, estrogen helps the endometrium (the inner lining of the uterus) become increasingly thick. It prepares to receive a potential embryo, the result of fertilization of the released egg.
There are certain occasions when ovarian function is not adequate or there are obstacles that hinder the connection between egg and sperm. In these cases, it is advisable to extract the eggs from the woman's body through ovarian puncture to fertilize them in the laboratory. This process requires prior ovarian stimulation.
The hormones administered are completely safe because they are the same ones a woman naturally produces. However, it is true that these hormones are administered in quantities greater than those naturally produced during a menstrual cycle. This causes a series of side effects that should be reported. Each case is unique, and therefore each woman will respond differently to treatment.
The most common side effects of hormonal stimulation are:
These are temporary side effects generally due to the increase in ovary size following treatment. Ovulation stimulation is closely monitored by doctors to avoid any complications.
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