Hormonal stimulation

Ovulation is a prerequisite for obtaining pregnancy. To accomplish this, a follicle containing the ovum is formed in the first days of the monthly cycle.

In some cases, a hormonal stimulation of the ovaries is required because:

  • there is a hormonal disorder which prevents ovulation
  • a higher pregnancy rate can be obtained when more than one ovum is released during ovulation

To this end, either pills (e.g. Clomiphen) or injections (e.g. Puregon, Gonal-F or Menopur resp. Merional) can be used.

It is important to monitor the hormonal treatment via ultrasound examinations and sometimes via hormonal tests of the blood or urine. In this way, it can be seen whether the hormonal treatment is working, whether a change in dosage is necessary or whether the stimulation is causing the formation of too many follicles. In the latter case there is a risk of a multiple pregnancy. The patient is advised not to have unprotected intercourse and not to undergo a possible planned insemination.

In extremely rare cases, the hormonal treatment can lead to the formation of ovarian cysts or of excessive amounts of follicles. However, it is also possible that despite a high-dosed hormonal treatment the ovaries do not react. In this case, the therapy should be terminated and a new attempt should be made at a later time with a different form of stimulation.

What does a high number of ovocytes mean?

An essential first step in fertility treatment is the hormonal stimulation of the ovarian follicles. In normal cases this leads to a ripening of more follicles. The increased number of follicles mean two things:

  • It leads to enlargement of follicles and through this to a sensation of pressure in the abdomen and a swelling of the stomach; over-stimulation results from a particularly high number of follicles developing.
  • Many egg cells are gathered from these follicles; far more than can be transferred back as embryos. The remainder of the high quality embryos can be frozen and stored while those of poor quality are discarded. This might make some couples uncomfortable.

Smart - Soft - Mild IVF?

Recent years have shown a trend to reduce the hormonal dosage used in the stimulation process. This approach, which is referred to as “Smart-IVF”, “Soft-IVF” or “Mild-IVF,” results in a smaller number of follicles as well as egg cells and, therefore, also embryos.

  • The advantages of this new strategy lie in the decreased hormonal burden on the woman. Side effects are smaller, less frequent and the treatment results in less embryos that need to be discarded at the end of the process.
  • The decisive disadvantage is the reduced pregnancy rate and the danger of a too small response by the follicles leading to a necessary termination of the treatment even prior to the puncture procedure.

However, due to the fact that this treatment is overall less stressful and demanding than one following a high-dosage stimulation, more women consider undergoing a repeated treatment.