Everything you need to know about ovarian stimulation

Ovarian stimulation is a hormonal treatment whose objective is to achieve quality ovulation in order to become pregnant. This medical gesture often the first to be prescribed in an assisted reproduction course, can be performed alone or prior to in vitro fertilization (IVF) or intrauterine insemination (IUU). Ovarian stimulation is generally very well tolerated, although it does have some side effects that you should be aware of.

« A woman who does not ovulate or has a cycle every forty days has practically no chance of becoming pregnant: no more than 4-5% per year. By stimulating her ovaries, we give her the same chances of pregnancy as in nature, ie 20 to 25% per cycle for a woman under 35. “, explains Véronique Bied Damon, gynecologist in Lyon, specialist in reproductive medicine.

In a typical menstrual cycle, the ovary produces one follicle. At the time of ovulation, the ovum releases an egg, which may or may not be fertilized by a sperm. Ovarian stimulation or ovulation induction therefore consists in giving hormones to a woman in order to reproduce this phenomenon. The purpose of this treatment isinduce the maturation of a follicle and thus enable ovulation.

This practice is for all women who do not become pregnant due to pregnancy ovulation irregular or absent. Ovarian stimulation is often the first step before more serious treatments, particularly in vitro fertilization (IVF) and insemination. There are few contraindications to this gesture, but note that women with hypotalamo-pituitary tumor, thrombosis, cerebrovascular accident (CVA), cancer or a history of serious bleeding disorders may not benefit from these treatments.

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What is simple ovarian stimulation?

We speak of simple ovarian stimulation when there is none no egg retrieval B. for in vitro fertilization (IVF) or artificial insemination, but that it is simply a matter of getting the ovaries to work for ovulation. ” It is used to correct ovulation disorder, polycystic ovaries, ovarian failure, menstrual cycle abnormalities », clarifies the specialist.

Ovarian stimulation as first treatment before IVF or UUI: how many follicles does it take to get pregnant?

You may also be prescribed ovarian stimulation along with IVF or UUI. In particular, this can be IVF with intracytoplasmic sperm injection (IVF with ICSI). In this case, the aim of the stimulation is to allow a larger number of oocytes to mature at once. The many follicles are then removed.

Véronique Bied Damon states that there is a particular economic interest in this practice: ” Here we carry out what is known as controlled ovarian hyperstimulation. The ovaries are stimulated with a double dose compared to a single stimulation, since the number of IVF reimbursed by social security is only four, but the embryos can be frozen. So you want a lot of eggs for each IVF attempt. We will have 10 to 12 on average. Half will give embryos. We transfer 1 or 2 and freeze the others for later transfers that do not count as IVF attempts. »

When to start ovarian stimulation?

Ovarian stimulation is started after a series of tests that are quite lengthy and restrictive but essential. The first step is a detailed interview and clinical examination with your gynecologist to assess the reason for the infertility within the couple. Then he or she will prescribe Blood samples to measure various hormones (FSH, LH and estradiol), as well as a pelvic ultrasound in a specialized practice. If you are not ovulating, you must take it Duphaston that triggers your period. Only after this step can you start the ovarian stimulation treatment.

Injection, Clomid… The different protocols

Three types of treatment are possible with ovarian stimulation:

  • Of medication (essentially clomiphene citrate, known as Clomid) to be taken orally. They have an antiestrogenic effect. The advantage: These are tablets that have to be taken daily for 7 days per cycle and are therefore less restrictive than other methods. They induce a FSH secretion, the hormone responsible for the growth of the follicles, leading to the stimulation of the ovaries. ” Although it is the least precise stimulation technique, it is often prescribed as a first line treatment, mainly in young women and in cases of polycystic ovaries. “, explains Dr. bied damon
  • Of Injections d’Hormone : l’Hormone FSH. Gonadotropins (FSH) in injectable preparations act directly on follicle production in the ovary. They are managed by bites (intramuscular, intradermal or subcutaneous). ” Women inject the product daily, mostly in the evening, for a period that extends from the 3rd or 4th day of the cycle to the time when ovulation is triggered, that is, the 11th or 12th day, but this duration is subject to the hormonal response of each. ‘ the gynecologist continues. This protocol therefore takes place every month for ten days for six months.
  • Less popular, the GnRH pump supplies the hormone that some women lack (gonadorelin) to enable ovulation. They must wear this pump until they are pregnant.

Sometimes you have to try several treatments before you find the one that suits you… Wait!

Side effects, risks and even dangers: What are the consequences of this hormone treatment?

There are no side effects with the LRH pump. Treatment with Clomid causes few side effects, except sometimes visual disturbances, headaches, indigestion and nausea. In some cases, this drug can also have an adverse effect on cervical mucus, requiring treatment with estrogens. Hormone injections, on the other hand, are often associated with a feeling of heaviness in the legs, a feeling of heaviness in the lower abdomen or even indigestion.

More serious and fortunately less common is the syndrome ofOverstimulation of the ovaries causes swelling of the ovaries and the presence of fluid in the abdominal cavity. This phenomenon occurs whentoo many follicles have matured. « In 1% of very severe cases, this may require hospitalization due to the risk of thrombosis or pulmonary embolism », emphasizes Véronique Bied Damon.

Know that a dual monitoring, biological and ultrasonic, is necessarily added during ovarian stimulation. Ultrasound makes it possible to measure the follicles and thus monitor their growth, and hormone tests (through blood tests) aim to control estradiol levels. They also indicate the measurement of hormone secretions and follicles. The goal of this Monitoring of ovulation is also to adjust the treatment, to prevent the risks of multiple pregnancy (by increasing or decreasing hormone intake), to indicate the ideal time for sexual intercourse and, if necessary, to induce ovulation, most commonly by injecting HCG that mimics the LH surge (l’ovulation trigger).

Fatigue, weight gain…

The most serious and common effect of ovarian stimulation is psychological. Stress, tiredness… it is important that you feel relaxed during this treatment. Some women also report rapid weight gain, which worries patients. Rest assured, it’s not common and is hormone related: so it’s temporary.

Pain: Is it normal to have pain after ovarian stimulation?

It is quite possible that you will experience discomfort during your hormone treatment. The patients experienced abdominal pain, headaches, but also nausea, dizziness… These side effects are rare: do not hesitate to report them to your gynecologist. When following a protocol with a GnRH pump, you may also experience discomfort (itching, redness, or swelling) at the injection site.

Links to the development of endometriosis

Practitioners have reported that one of the side effects of taking Clomid (clomiphene citrate) is the development or even new endometriosis that is already present. Fortunately, this remains extremely rare.

Response to treatment varies from woman to woman. It all depends on the cause of your infertility, your age, your history… When the right treatment is found, it’s like the first link in the chain is restored. Pregnancy is usually observed during the first four months.

If ovarian stimulation doesn’t work, it’s possible to start over. In France, health insurance has not set a limit on the coverage of ovarian stimulation. Gynecologists sometimes prefer to spread out the treatments and rest the ovaries at least every other cycle. Experts seem to agree that there is little point in continuing ovarian stimulation in the absence of pregnancy at the end three to six months probationary periodbecause hormone treatments then become less effective.

The testimony of Élodie, 31 years old, 4 ½ months pregnant: “The 4th insemination was the right one! »

« I turned to ovarian stimulation because I had polycystic ovaries, meaning I didn’t have regular cycles. We started stimulation with Gonal-F injections, which I gave myself, about a year ago. It lasted ten months, but with breaks, so a total of six stimulation cycles and four inseminations. The 4th was the good one and I am now 4 months and a half pregnant! Regarding the treatment, I didn’t feel any side effects and tolerated the injections well. The only caveat was making myself available for estradiol checks every few days, but that was doable. »

In the video: “A PMA for a child”

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