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Starting Fertility Treatment

Part 2 – Ovarian Stimulation

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They are closely associated with human growth and are essential for the metabolism. Human reproduction processes are mainly controlled by them. Hormones: messenger substances, thus playing a crucial role at the beginning of each IVF treatment. Hence, following the initial consultation, the woman provides a decisive boost by undergoing hormone therapy (ovarian stimulation).

About the background:

What is the nature of ovarian stimulation?
Since in the “natural” menstrual cycle of a woman several oocytes start to ripen, on average about 10 follicles (containing the maturing oocytes) compete for dominance each month. Only ONE follicle becomes the so-called dominant follicle containing the mature oocyte. The other follicles stop developing. This is exactly where hormonal stimulation comes into play:
The woman needs to take appropriate hormone medication (e.g.: gonadotropins = pituitary hormones) in order to induce as many of these follicles – that would otherwise loose the battle for dominance – to grow further and produce a mature oocyte. This requires a targeted and exactly timed approach.

Start of stimulation on the appropriate cycle day
The treating doctor defines the entire stimulation period (+/- 2 to 3 days) on the basis of the woman’s menstrual cycle. Ovarian stimulation is started in accordance with a customized treatment plan. At the IVF Centers Prof. Zech we mainly use the so-called long-protocol in IVF treatment.
Since hormonal therapy has to be realized in a highly accurate manner, each couple will be provided with extensive information that will be sent by post, by e-mail or handed over to them personally. In addition, the couple maintains constant close phone contact with the IVF center.

Usually the first phase of therapy – the so-called down-regulation (e.g. by using the drug “Decapeptyl”) – starts about 7 days before the next menstruation is to be expected, and may thus vary depending on the length of a woman’s cycle. The medication must be administered at the same time every day via subcutaneous injection (SC). Injection sites on the abdomen and thighs are most suitable for administering the medication. This medicine has to be stored in a cool place. A slight feeling of itching may occur at the injection site during the administration. Side effects are rare, but may include hot flashes, restlessness, insomnia, spotting, headaches etc.
During down-regulation, the natural menstrual bleeding pattern is interrupted. A withdrawal bleeding must occur during this protocol, but it may be delayed since this process is an artificial one. The bleeding during down-regulation can either be very heavy or very light. Spotting is most common. At this stage, a “natural” pregnancy may still occur without being affected by this.

Stimulation phase with a preparation containing both FSH and LH
Ovarian stimulation using an FSH/LH preparation begins in parallel with down-regulation, provided that menstrual bleeding has already started. The following medications are most commonly used for ovarian stimulation: “Merional“, “Menogon“ or “Menopur“.

“We like using Merional IM, as this preparation features the important LH in an optimum relation”, emphasizes Dr Nicolas Zech, Medical Director of the IVF Centers Prof. Zech in Bregenz.

The stimulation preparation is injected into the gluteal muscle (buttocks) (intramuscular injection, IM). Prior to self-injection, this injection technique has to be demonstrated and explained to the patients by a healthcare professional. A medical employee can instruct the couple on how to perform an injection themselves. The stimulation preparation must be injected at approximately the same time each day (+/- 2 hours ok). Drugs such as “Decapeptyl” may be administered either simultaneously or at different times. After the sixth stimulation day, the patient should undergo the first trans-vaginal ultrasound scan. Ultrasound examination can either be performed by the woman’s gynecologist or directly at one of our IVF Centers Prof. Zech.

You will learn more about ultrasound examinations and follicle monitoring in the third and final part of our series: “Starting Fertility Treatment”. Just click here to find a 10-step summary containing more detailed information on the entire treatment sequence.

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Part 2 – Ovarian Stimulation