The goal of ovarian stimulation treatment is to promote the maturation and ovulation of one or more mature oocytes.
A distinction is made between mono- or bifollicular stimulation, which is used to treat ovulation disorders or as a prerequisite for intrauterine insemination (IUI), and plurifollicular stimulation, which is performed as part of in vitro fertilization (IVF) protocols.
SIMPLE OVARIAN STIMULATION
The goal of simple ovarian stimulation is to promote the development of one or two mature follicles, allowing for the release of one or two mature oocytes that can be fertilized naturally
Two types of medications are commonly used for this treatment: clomiphene citrate or gonadotropins. Clomiphene citrate is taken in tablet form at the beginning of the cycle, whereas gonadotropins are administered as injections, starting earlier or later in the cycle depending on body weight, follicle count, and AMH levels.
Between days 10 and 12 of the cycle, the response to treatment is assessed through pelvic ultrasound and blood tests. This monitoring ensures that the number of developing follicles remains within the desired range and allows for treatment adjustments if necessary.
Once the follicles reach maturity (typically between 16 and 20 mm in size), ovulation is triggered with an hCG injection. Ovulation occurs 36 to 40 hours later.
Simple ovulation stimulation is recommended for women with ovulation disorders as part of a scheduled intercourse protocol. It is also used in intrauterine insemination (IUI) protocols.
This treatment is generally well tolerated. The primary risk associated with ovulation stimulation for scheduled intercourse or IUI is the possibility of multiple pregnancies.
PLURIFOLLICULAR STIMULATION
The goal of plurifollicular stimulation is to promote the simultaneous growth of multiple follicles on both ovaries within the same cycle.
This type of stimulation represents the first step in in vitro fertilization (IVF) and IVF-ICSI treatments. It involves approximately ten days of gonadotropin injections, along with close monitoring through pelvic ultrasound and blood hormone level assessments.
Plurifollicular ovarian stimulation is generally well tolerated, although some women may experience pelvic discomfort or a sensation of heaviness toward the end of the IVF cycle due to the increased ovarian volume.
The primary complication associated with this treatment is ovarian hyperstimulation syndrome (OHSS), which occurs primarily in young women with a high ovarian reserve. To minimize this risk, tailored stimulation protocols should be selected for at-risk patients.
