Controlled ovarian stimulation is an essential part of assisted reproductive technology in which fertility medications (containing FSH, LH) are given to the patient to produce an optimum number of oocytes for in vitro fertilization.
RESPONSE PREDICTION
Response predictors are the factors which are important to determine the protocol for stimulation, dosage of medication, cost of treatment.
1 Antral Follicle Count (AFC) – It is a test to determine the ovarian reserve (i.e. the number of egg containing follicles or sacs which develops in the ovaries).
Transvaginal ultrasound is performed in the early stages of menstrual cycle to estimate the AFC.
2 AMH (Anti-Mullerian Hormone) – This hormone is produced by the granulosa cells of the developing oocyte in the female ovaries .AMH test is used to estimate the ovarian reserve of eggs in females.
3 FSH and ESTRADIOL Levels
4 Maternal age
5 Body mass index
6 Menstrual cycle
7 Previous surgeries, medications, allergies.
PROCEDURE
- Prevention of spontaneous ovulation – Medication are given to the patient to prevent premature ovulation before the egg retrieval.
There are two methods to prevent premature ovulation-
1 GnRH Agonist- Gonadotropin releasing hormone cause the anterior pituitary gland to release FSH and LH. First dose of GnRH increases the activity of pituitary gland. However pituitary gland after few doses of GnRH stops responding to it. Example of GnRH agonist are Lupron, zoladex, synarel, suprecur.
2 GnRH Antagonist – Cetrotide or ganirelix is used to prevent premature ovulation. This protocol is started on the 2nd or 3rd day of previous menstrual cycle.
These two methods are used by the Doctor to control or regulate the menstrual cycle so that medications can be given to produce good quality and quantity of oocytes and the eggs can be retrieved before ovulation.
STIMULATION
HORMONAL INJECTIONS are given to the patient from the day 2 or day 3 of menstrual periods for the production of oocytes.
The dosage of the hormonal injections (containing FSH and LH) depends upon the E2 level, AFC test, and AMH test.
Examples of hormonal injections are recagon, gonal f, and follisurge.
Along with the above mentioned injections some injections containing helping hormones like HMG, Luveris, creat may be given to the patient.
Recagon, Gonal F, follisurge are injected subcutaneously while HMG is injected intra –muscularly.
These injections are given for 9-12days.
After 9-12 days of stimulation when the size of largest follicle is 14-18 mm a final dose of ovitrille injection is given to the patient.
After 36 hrs eggs are retrieved from the ovaries when the oocyte size is 20-22mm.
After oocyte retrieval, the eggs and sperms are inseminated.
3-5 days embryo is transferred in the uterus of the female.
RISKS OF OVARIAN STIMULATION
1 Ovarian hyper stimulation syndrome (OHSS) – It results due to exaggerated response to excess hormones.
2 Mild to moderate abdominal pain
3 Abdominal bloating or increased waist size
4 Vomiting, diarrhea
5 Tenderness in the surrounding areas of ovaries
ADVANTAGES
1 Controlled ovarian stimulation is used to treat patients suffering from endometriosis, fibroids.
2 It is used to develop multiple oocyte for IVF.
3 It is used to treat infertile couples
