Fertility Institute of San Diego
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Controlled Ovarian Stimulation

During a woman’s natural menstrual cycle, usually one mature egg develops controlled ovarian stimulation causes multiple eggs to develop.

This is housed in a small cystic structure called a follicle. The follicle stimulating hormone (FSH) is the primary hormone responsible for the growth of the follicle. FSH is released from the pituitary gland within the brain. As the follicle grows, it produces a hormone called estradiol, which is an estrogen. When the follicle reaches a mature size, a large amount of luteinizing hormone (LH) is released from the pituitary gland. The purpose of this LH surge is to help mature the egg and leads to ovulation approximately 36 to 40 hours later.

The goal of IVF is to develop multiple follicles, which will lead to the retrieval of multiple eggs thereby increasing the potential number of fertilized eggs or embryos.

The pregnancy rates increase with increased number of embryos transferred.During the process of controlled ovarian stimulation, the response to the medications used will be determined by transvaginal ultrasound and periodic blood hormone tests. The monitoring helps Dr. Hosseinzadeh to determine the appropriate dose of the medications and the timing of the egg retrieval. Vaginal ultrasound uses sound waves and is usually painless. The blood hormone testing may be associated with mild discomfort and possible redness, bruising, bleeding and rarely infection. Monitoring may be required as often as once a day to document follicular development.

Various protocols will be used to achieve controlled ovarian stimulation. Dr. Hosseinzadeh will determine the protocol that best suits you. There are several medications that can be used for the ovarian stimulation.

Learn more about medications here.

Side effects of fertility medications

Although the medications listed in the medications section above are usually well tolerated, they can cause various side effects including but not limited to nausea, vomiting, irritability, mood swings, hot flashes, night sweats, sleeplessness, headaches, dizziness, joint problems, weight gain, weight loss, as well as visual difficulties. These side effects are generally temporary. Rarely allergic reactions can also occur.

Other more serious side effects include:

Ovarian Hyperstimulation Syndrome (OHSS):

This syndrome is characterized by the development of multiple ovarian cysts. The cysts are the follicles that fill up with fluid after the egg retrieval and result in ovarian enlargement. The typical presentation is lower abdominal discomfort, bloating and distention. The symptoms generally occur one to two weeks after the egg retrieval and resolve within one to two weeks without intervention. During this time, we usually recommend a period of reduced activity and possibly bed rest. It is known that if you get pregnant in a cycle that is complicated by OHSS, the symptoms are usually more severe and it takes longer for the symptoms to resolve. In rare cases the syndrome can be severe with accumulation of fluid in the abdominal and/or the chest cavities. In this case the ovaries are even further enlarged and patients present with severe abdominal pain, bloating, weight gain, shortness of breath, nausea, vomiting and decreased urinary output. In extremely rare circumstances this can lead to the formation of blood clots in the legs (deep vein thrombosis), and lungs (pulmonary embolus). Such complications may require hospitalization. It is imperative that you contact Dr. Hosseinzadeh should you develop any of these symptoms. If Dr. Hosseinzadeh judges that you are at an increased risk for developing OHSS, your cycle will be cancelled or your eggs will be retrieved, fertilized, and the resulting embryos will be frozen. The embryos will not be transferred in that cycle. Once the OHSS has subsided, your embryos will be transferred in a subsequent frozen embryo transfer cycle thereby eliminating the risk for developing OHSS.

Ovarian Torsion (twisting of the ovary):

In rare cases, due to the fluid filled cysts in the ovary, the ovary can twist on itself and in the process compromise its blood supply. Surgical intervention may be required to untwist the ovary and occasionally it may become necessary to remove the ovary. It is important that you contact Dr. Hosseinzadeh if you should develop abdominal pain.
Ovarian Cancer:

Limited studies have shown a higher correlation than normal of ovarian cancer in patients who have used ovulation induction drugs such as clomiphene citrate and gonadotropins. However, to date, no cause and effect correlation has been clearly established.

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