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    OVARIAN STIMULATION

    Controlled ovarian stimulation, using specific pharmaceutical medication, is a customized treatment for every patient in order to achieve the best possible results and to avoid complications. Women who follow an ovarian stimulation program continue their daily activities normally.

     

    In general, the drugs used in ovarian stimulation protocols are:

     

    • Gonadotropins which stimulate the ovaries!

    Are administered in the form of injections, usually subcutaneously, on the abdomen or the thigh with a small insulin-type needle, around the same time every day.

     

    The dosage (how many ‘units’ of the medication) is adjusted depending on many parameters of the patient (hormonal status/BMI etc) even between different cycles of the same patient and according to the progress of each cycle.

     

    Various gonadotropin medication regimes and different hormones can be subscribe (FSH, LH, combination) and their origin (recombinant or human / purified).

     

    • Analogues of GnRH, Gonadotropin-Releasing Hormone.

      GnRH stimulates the release of gonadotropins. The administration of analogues of
      that hormone achieves suppression of endogenous gonadotropins in women (those
      which her own body produces). This supression allows us to have full control of the
      situation (since we can adjust the stimulation with gonadotropin injections), and also
      ensures us that a sudden increase in endogenous LH will not occur. In such a case, the
      sudden increase would result in a mistimed ovulation and thus inevitable cancellation
      of the effort.

    • There are two basic types of GnRH analogues (agonists and antagonists), which differ in the way and the needed time to achieve the suppression.
    • The analogues are administered daily at about the same time, in the form of subcutaneous injections, or rarely as inhaled drugs.



    Several protocols of controlled ovarian stimulation, which differ as to when to start hormonal suppression with the administration of analogues, may be suggested:

    • The long protocol, where we begin the daily injections of the analogue from the previous stimulation cycle (around seven days before the expected first day of the period) and after the starting of the period (since the success of suppression is confirmed by measuring estradiol blood levels) we can start ovarian stimulation by administering gonadotropins.
    • The short protocol, where we start the analogue injections on day 2 of the period and the next day (the 3rd day of the period) we also start gonadotropin injections.
    • The antagonist protocol, where we first start gonadotropin injections on day 2 of the period and continue by adding the antagonist injections when developing follicles have a mean diameter of 14-15 mm, which is about the 6th-7th day of stimulation.



    Recombinant Human Chorionic Gonadotropin (hCG) administration confirms the end of the stimulation period!!!

    Is injected with a single dose at the right time to trigger the final follicular and oocyte maturation and egg retrieval is scheduled approximately 34-36h later.

    For any woman undergoing ovarian stimulation, the close monitoring by the attending physician with successive ultrasounds scans and hormonal assays is absolutely crucial.

    FAQs About ovarian stimulation

    What is the cost of the medication?

    The required medication which is used in the Assisted Reproduction Therapies has a significantly high cost and consequently, many times the couples are concerned about this extra cost. However, through the ΕΟΠΥΥ (National Organization of Health Services Provision), insured that any patient can be provided with these medical supplies free of charge, after applying to a special Committee.

    What are the side effects of the drug administration?

    In the majority of women who take medication for ovarian stimulation in order to attempt a cycle, the hormone intake does not cause any special problem. A small percentage of women may develop slight swelling or small retention, which are bearable symptoms of no significant evaluation.

    Cancer and ovarian stimulation

    There are some risks to be aware of, which followed the hypothesis that long IVF treatment process may lead to some kind of cancer (i.e. breast or ovarian cancer) among IVF candidates. The conclusion in the bibliography indicates that the risk of breast cancer may be increased, but in those women with a positive family history and related inherited genes. 

    Furthermore, the association between infertility drugs and ovarian cancer needs to be addressed with consideration of other factors such as age, body mass index, parity, genetic factors (i.e. family history for ovarian cancer), and etiology of the infertility, along with longer follow-up times.

     (Resources: In-Vitro Fertilization Impact on the Risk of Breast Cancer: A Review Article, 2021; Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility (Review), 2019 )

    We are here to answer any questions and discuss with you.