Ovarian stimulation: a helping hand to get pregnant?

What is ovarian stimulation?

It’s giving nature a helping hand when a baby is late in coming, and it’s due to an ovulation abnormality. “A woman who doesn’t ovulate or cycles every 4 days has virtually no chance of getting pregnant – no more than 5-20% per year. So by stimulating her ovaries, we give her the same chances of pregnancy as in nature, ie 25 to 35% per cycle for a woman under XNUMX years old, ”explains Dr Véronique Bied Damon, gynecologist specializing in reproductive medicine. .

How does ovarian stimulation work?

“There are two types of stimulation,” she explains. First, the one whose goal is to reproduce physiology: the woman is stimulated to obtain one or two ripe follicles (or ova), but no more. This is the case of simple stimulation with the aim of correcting an ovulation disorder, polycystic ovaries, ovarian insufficiency, an anomaly of the cycle; or to prepare the woman for artificial insemination. »The ovaries are moderately stimulated to avoid the risk of multiple pregnancy.

“Second case: stimulation in the context of IVF. There, the goal is to recover the maximum number of oocytes, 10 to 15, at one time. This is called controlled ovarian hyperstimulation. The ovaries are stimulated at a double dose compared to a single stimulation. ” Why ? “The number of IVF reimbursed by Social Security is four, and we can freeze the embryos. So for every IVF attempt, we want a lot of eggs. We will have an average of 10 to 12. Half will give embryos, so about 6. We transfer 1 or 2, we freeze the others for subsequent transfers which do not count as IVF attempts. “

What drugs to start stimulation? Tablets or injections?

Again, it depends. “First there are the tablets: clomiphene citrate (Clomid). This stimulation has the disadvantage of not being very precise, a bit like a 2 CV compared to a modern car; but the tablets are practical, it is what one will give in first intention rather in the young women, and in the event of polycystic ovaries ”, explains Dr. Bied Damon.

Second case: subcutaneous punctures. “Women inject the product daily, rather in the evening, for a period extending from the 3rd or 4th day of the cycle until the moment when ovulation is triggered, that is to say the 11th. or 12th day, but this duration depends on the hormonal response of each. So, ten days a month, for about six months, the woman injects either recombinant FSH (synthetic, like Puregon or Gonal-F); or HMG (human menopausal gonadotropin, such as Menopur). For the record, this is highly purified urine from postmenopausal women, because when postmenopausal, more FSH, a substance that stimulates the ovaries, is produced.

Are there any side effects to ovarian stimulation?

Potentially yes, as with any medication. “The risk is ovarian hyperstimulation syndrome”, fortunately very rare and very watched. “In 1% of very severe cases, this may require hospitalization because there may be a risk of thrombosis or pulmonary embolism.

At what age should ovarian stimulation be done?

It depends on the age and the specific case of each patient. “A woman under 35 who has regular cycles can wait a bit. The legal definition of infertility is two years of unprotected sex for a couple without pregnancy! But for a young woman who only has her period twice a year, there is no point in waiting: you have to consult.

Likewise, for a 38-year-old woman, we are not going to waste too much time. We will say to him: “You have done 3 cycles of stimulation, it does not work: you might as well go to IVF”. It is on a case-by-case basis. “