Stimulating

Stimulating your ovaries:

To maximize the number of eggs we collect, you will start daily injections of stimulating hormone over a period of 10-12 days. During this time, we’ll monitor your response with blood tests and ultrasound scans and optimize your medication doses..

A few days after your period starts (either following medication or normal start without medication), you will go to your fertility clinic for a baseline vaginal ultrasound. This ensures that you don’t have any cysts in your ovaries, the lining of your uterus is thin, and confirm that your ovaries are in a resting state so that you can start stimulation medication.

This involves taking injections that are synthetic or purified forms of FSH and LH (also called gonadotropins), which are more potent than what your body makes naturally. You will take these injections subcutaneously every day. The injections are given just below your skin, have minimal discomfort, and feel like a sharp pinch. As you take your injections, multiple follicles will grow and will make more and more reproductive hormones (mainly estrogen and a small amount of progesterone).

Next, you will take another subcutaneous injection called either GNRH agonist or GNRH antagonist. As your follicles continue to grow and produce more and more estrogen, the brain signals your ovaries to release eggs prematurely before they are retrieved. This injection prevents your brain from telling your ovaries to release eggs before we can collect your eggs during the egg retrieval procedure.

Over the next 8-12 days, you will take your injections and come into the clinic for 3-5 short visits (usually 15-20 minutes each) to have ultrasound examination. During the monitoring visits, we will measure both the thickness of the lining of your uterus and the size of your follicles. In response to the increasing levels of hormones, your follicles will become progressively larger, and the lining of the uterus will become thicker. We may adjust your hormone injection dose based upon the results of each monitoring visit. After each visit, we will review any adjustments in your medication dose and schedule the next visit.

We will monitor your follicle sizes closely until the largest follicles (also called lead follicles) reach an average size of 18-22 mm. At this point, we will determine the best timing for you to take your final medication (the “trigger shot”) to help the eggs in the follicles reach maturity.

Once stimulation has been completed and follicles have reached their optimal sizes, it is time to proceed with an injection (subcutaneous, intramuscular, or both) to trigger ovulation. This medication causes eggs in the follicles to mature, thereby initiating the ovulation process. Many women will ovulate and release eggs from their follicles 37 to 38 hours following the trigger injection.

Next step: 4. Collecting