Ovarian stimulation which happens in the second stage of IVF fertility treatment is integral to the success of the procedure. In the usual scenario the ovaries release one egg per month during ovulation. The aim of the stimulation is to harvest maximum number of mature eggs from the woman’s ovaries. The chances of the eggs getting fertilized is consequently maximized. The IVF success rate is often less successful when only a few eggs are recovered. The ovarian stimulation procedure can take around 8 to 14 days for optimum follicular development. Approximately 8 to 15 mature follicles with sizes of 14-20mm diameter that can produce quality eggs at the egg retrieval stage is the goal of this whole process.
The woman will have to undergo thorough testing to ensure that there aren’t any potential complications during ovarian stimulation. An ultrasound test called the antral follicle count can help test the ability of the ovaries to stimulate well to make many follicles. The number of follicles required for the IVF treatment is taken into account based on several factors like the follicle size, the woman’s age, earlier IVF stimulation results and the couple’s willingness to agree to egg retrieval if the need arises.
During the ovary stimulation procedure, the IVF specialist injects medicines to stimulate the Follicle-stimulating hormone (FSH) or Luteinizing Hormone (LH). This in turn triggers the ovaries to produce more mature eggs. Right before the ovulation process in the body there is a likely increase in the LH levels. A trigger shot of hCG or Human Chorionic Gonadotropin is injected for better ovulation. And again, if the woman’s follicles are slow then the medication may need to be administered for a longer period. Good timing and utmost care are definitely the cornerstones of this ovarian stimulation procedure. Both overstimulation and under stimulation have found to cause the procedure to fail. So, the trigger injections have to be at the right time and of the right dose.
An overstimulation can cause considerable discomfort for the woman leading to something called ovarian hyperstimulation syndrome, OHSS and at the same time inadequate stimulation can result is so few eggs. So, these synthetic follicle stimulating hormones”, or Human Menopausal Synthetic Follicle Stimulating Hormones, HMG has to be administered only by an experienced fertility specialist. It is the specialist’s responsibility to choose the right medication protocol and dosing regimen and also continually monitor stimulation progress so the medication doses can be adjusted accordingly. Extreme quality control throughout the process is a priority in vitro fertilization.
The important factor in ovarian stimulation is monitoring the estrogen or estradiol levels. The normal levels will be at 60 pg/ml and this peaks in IVF and during an HCG injection to around 1000 and 4000 pg/ml. The developing follicle sizes are measured using an Ultrasound. The HCG injection is given when the estrogen level and the follicle measurements are at their best for successful IVF outcome. Final egg maturation will also require an HCG shot. Around 34 to 35 hours after giving the HCG injection and egg retrieval will be planned as this is right before the woman begin ovulation.
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