Ovarian stimulation in IVF

Often the reason for which pregnancy does not occur is hormonal failure in the body of a woman. It negatively affects the activity of the ovaries and the condition of the endometrium. In this case, reproductive specialists prescribe drugs that suppress the natural production of hormones, replacing them with artificial ones. This ensures the correct and enhanced work of the ovaries.

Who is ovarian stimulation indicated for IVF

In a woman’s natural menstrual cycle, one, rarely two, eggs mature. At the stage of ovarian stimulation, due to the use of hormonal drugs, several eggs can mature at once. (one)

The stimulation procedure is indicated in a number of cases.

• Anovulatory cause (lack of ovulation in a woman), not treatable by other methods.
• Male factor infertility.
• Absence or obstruction of the fallopian tubes.
• The uterine factor of infertility is a congenital or acquired (surgical operation) absence of an organ, surrogate motherhood is necessary.
• Unexplained infertility.

How is ovarian stimulation performed during IVF?

For each patient, an individual treatment regimen is selected, which is called a protocol. Depending on age, chronic diseases, causes of infertility and allergic reactions, the reproductive specialist decides which one. The action of all protocols is characterized by partial or complete suppression of follicle-stimulating and luteinizing hormones (LH). They are replaced by artificial counterparts. The process of ovarian stimulation is monitored using an ultrasound sensor in order to adjust the dosage of the drug in time or replace it if necessary. Normally, every day the endometrium should increase by 1 mm, and the follicles by 2 mm (2).

Types of protocols

Short protocol

With a short protocol, pituitary blocking is not performed. Stimulation of ovulation begins on the 2nd or 3rd day of the menstrual cycle. Gonadotropin preparations are administered within 10-14 days. Doses of drugs are selected individually. After the maturation of the follicles, chorionic gonadotropin (hCG) or a gonadotropic releasing hormone (GnRH) agonist is injected, after 36 hours the follicles are punctured. The puncture in the short protocol is carried out on the 12th-15th day of the menstrual cycle.

Long protocol

This protocol is indicated if a woman is diagnosed with endometriosis, ovarian cysts, benign neoplasms, if poor quality eggs are obtained in a short protocol. The process begins with the blockade of LH and GnRH. In the second (luteal) phase of the menstrual cycle, i.e. on the 20-21st day, drugs are prescribed – agonists of gonadotropic hormones. These drugs suppress the production of ovarian hormones. On the 2-4th day of the next cycle, ovulation stimulation begins. Follicles mature 10-14 days, and when they reach a certain size, an ovulation trigger is prescribed – 36 hours before the follicle puncture, usually this happens on the 12-15th day of the cycle. That is, the puncture should approximately coincide with normal natural ovulation.

Super long protocol

Lasts up to six months and is indicated for endometriosis and fibroids. All this time, the ovaries are suppressed by LH blockade. When the size of the cysts or fibroids decreases, ovarian stimulation begins, which lasts about 10 days.

French protocol

It looks like a long protocol. The main difference is that gonadotropic hormone agonists are prescribed in minimal doses, so there is a partial blockage of the pituitary gland.

Shanghai protocol

This protocol is characterized by double stimulation during one menstrual cycle. Stimulation of the ovaries with hormonal drugs begins on the 2-3rd day of the cycle, then a puncture is performed, but 1-3 days after it, stimulating drugs are again prescribed for the maturation of new follicles. All embryos are frozen and the embryo transfer takes place in the next cycle.

Reviews of experts on ovarian stimulation during IVF

Comment by an obstetrician-gynecologist, reproductologist at the Remedi Institute of Reproductive Medicine Member of RAHR, ESHRE Larisa Falaleeva.

Stimulation of ovarian function in the IVF program is carried out in order to obtain more cells (eggs). It is carried out with the use of hormonal drugs in various forms (tablets, injections). In the process of stimulation, there are several important points, they determine how many quality cells we can get:

1. drugs are taken at the same time prescribed by the doctor;
2. drugs are stored (syringes-pens or vials with a dry substance) at a temperature of +4 … +24⁰C, they must be protected from direct sunlight, the period of use from the moment of opening is limited;
3. skipping the prescribed drug is not allowed (unless a pause is recommended by the attending physician);
4. the final drug (trigger, final cell maturation drug) is injected AT A STRICTLY SPECIFIED TIME, the time of the puncture depends on this, and, as a result, the production of high-quality cells capable of fertilization;
5. If you miss your scheduled injection time, be sure to contact your doctor.

The drugs in most cases do not have side effects. Sometimes they can cause a local reaction in the form of redness or itching, which pass quickly enough. Sometimes cause mood swings, tearfulness. These manifestations disappear after stimulation (3).

Reproductologist’s comment

– The appointment of one or another type of protocol is the responsibility of the reproductive specialist, – notes obstetrician-gynecologist, reproductologist of the clinic LLC “ECO Center” in Volgograd Lyudmila Shurshina. — Depending on the history, the presence of concomitant diseases, the history of previous ART programs, the doctor makes a decision. Advantages of a short protocol: it lasts much less, the risk of ovarian hyperstimulation is lower, smaller doses of administered drugs, which makes the program more financially profitable.

Cons of the short protocol: we get fewer eggs and more uneven growth of follicles than in the long protocol.

Regardless of the type after the puncture, the protocols are the same.

Popular questions and answers

Ovarian stimulation is one of the important stages of IVF. Naturally, women are interested in the nuances of the procedure. We will answer the most popular questions.

Sources of

1. Kuzmichev L.N., Shtyrya Yu.A. In vitro fertilization. Only facts. Information for reflection / 2012
2. Svorova M.S., Kravchenko E.N., Makarkina L.G., Krivchik G.V., Koveshnikova T.V. Ovarian reserve in patients included in in vitro fertilization programs / 2018
3. Lysenko O.V., Smirnova I.V. Medical and social characteristics of women aimed at IVF and analysis of unsuccessful attempts / 2010