Ovarian Stimulation and Monitoring

In Vitro Fertilization Program

Stimulation

Fertility drugs that mimic the body’s natural hormones are given daily by injection in hopes that three or more eggs will develop during the treatment cycle.  In general, the more eggs fertilized, the better the chance for pregnancy.  Fertility drugs commonly given in this program include the following:

1. Leuprolide (leuprolide acetate, Lupron)
2. Follicle Stimulating Hormone (FSH; Commercial names include, but are not limited to:  Follistim, Gonal-F or Bravelle)
3. Human menopausal gonadotropins (hMG; Commercial names include, but are not limited to: Pergonal or Repronex)
4. hCG (human chorionic gonadotropin, chorionic gonadotropin).
5. Antagon (ganirelix acetate) - may be utilized instead of leuprolide.

On the first day of your menstrual cycle proceeding the IVF cycle you will begin taking oral contraceptive pills (OCP’s) unless contraindicated.  You will initiate injections of leuprolide between the 21st and 35th day of OCP’s to suppress secretion of the naturally occurring hormones FSH and LH.  The physician can then control more precisely the amount of LH and FSH in your system by supplying it via injections.  The use of leuprolide (or Antagon) prevents a premature LH surge or ripening and release of eggs.

After at least a week of leuprolide and two to five days following the onset of a period, you will begin medications to stimulate development of ovarian follicles, sac-like fluid-filled structures in the ovary in which eggs develop and produce estrogen hormone.  While continuing the leuprolide injections you will first receive three days of FSH injections.  On the fourth day, FSH injections will be combined with hMG injections and will continue until at least two follicles have an average diameter of 18 mm and the estrogen levels are at least 500 pg/ml; this takes an average of ten days.  Once these follicular sizes and estrogen level minimums are attained, an hCG injection is given.

hCG is chemically very similar to LH (luteinizing hormone), which your body makes naturally.  In a natural cycle the event that brings about final maturation of the eggs and triggers their release from the follicle (ovulation) is a dramatic increase in LH, "the LH surge".  In ovarian stimulation for IVF, hCG is given to mimic the LH surge and bring about this final egg maturation.  Ovaries become tender and fragile during stimulation and it is recommended that you avoid strenuous activity after several days of stimulation.

Some patients utilize other stimulation protocols.  Your physician will determine which protocol is best for you and detailed information will be reviewed with you individually.

Monitoring

Careful monitoring helps control and optimize ovarian stimulation.  Your progress will be monitored through use of blood hormone monitoring and pelvic ultrasound.

Blood Hormone Monitoring: During ovarian stimulation blood is drawn in the morning every other day or so to follow estradiol (estrogen) levels.  Local labs can be used for estradiol monitoring if results can be available by 1 p.m. on the same day the blood is drawn.

Ultrasound Monitoring: As your stimulation progresses you will have periodic ultrasound imaging of your ovaries.  High-frequency sound waves, which cannot be felt or heard, can be bounced off body tissues to produce a visual image on a monitor.  Accurate pictures of the ovarian follicles can be produced with ultrasound so that the number, size and location of the follicles can be determined.  While you are lying on your back an ultrasound transducer, which emits sound waves and registers echoes, is placed in the vagina.  You will be able to watch the resulting image of your ovarian follicles on the screen