Ovarian stimulation For ART

During ovarian stimulation, induction, the hormones for egg growth and rupture, are given to stimulate multiple eggs to grow in the ovaries rather than one egg, so that the chance of getting a genetically normal egg capable of forming a normal baby is higher.

There are different methods if stimulating the ovary. The natural LH surge is prevented by the administration of drugs like GnRH agonists or antagonists so that the eggs can be picked up at the right time. The entire cycle has to be done under careful supervision with ultrasound as the chance of ovarian hyperstimulation is high.


The suppressant injections of GnRH agonists are usually started on D21 of the previous cycle after a scan and can be had with the local doctor. The stimulant injections for egg growth are started on day 2 of the menstrual cycle and have to be taken every day( can be done by the patient herself ) for 12 to 14 days under the supervision of the clinic, Periodic, Blood tests and scans have to be done to assess the progress of the follicular growth and readiness of the egg for retrieval. Generally, eight to 14 days of stimulation is required. When the follicles are ready, hCG or other medications are given. Normally, estrogen levels increase as the follicles develop, and progesterone levels are low until after ovulation. The hCG replaces the woman’s natural LH surge and causes the final stage of egg maturation so the eggs are capable of being fertilized. The eggs are retrieved before ovulation occurs, usually, 34 to 36 hours after the hCG injection is given.


The ovarian stimulation is started on cycle day 2 and the antagonist injections to prevent LH surge are started on day 6 or when the lead follicle reaches 14mm. The rest of the procedure is similar to the agonist protocol


Short(flare up) protocol, minimal stimulation, natural cycle IVF, microdose protocols are modifications of the above basic protocols. When the follicles have reached maturity, the HCG trigger injection is given and the eggs are harvested 35-36 hours later. Timing isT472.jpg crucial in an IVF cycle. The ovaries are evaluated during treatment with vaginal ultrasound examinations to monitor the development of ovarian follicles (Figure 2). Blood samples are drawn to measure the response to ovarian stimulation medications. Cancellation may be for a variety of reasons, usually due to an inadequate number of follicles developing especially after age 35. Occasionally, a cycle may be canceled to reduce the risk of ovarian hyperstimulation syndrome (OHSS). LH surges and ovulation occur prematurely in a small percentage of ART cycles despite the use of drugs. When this occurs, since it is unknown when the LH surges began and eggs will mature, the cycle is usually canceled

The patients undergo a thorough individual plan and are not batched together. The disadvantage of a blanket protocol to suit an outsourced teams arrival is not followed here. The embryologist and the geneticist are in the house and their role in maintaining the lab and procedureThis ensures better success and avoids the errors when too many embryos are in the same incubator. Similarly, when the cycle fails, detailed counseling with an analysis as to the cause of failure and corrective measures that need to be done are discussed by the head of the department in consultation. The team is highly sensitive to the needs of the patient and is a constant companion in the journey. The center specializes in low-cost soft cycles which have been especially successful in failed IVF and in women over 35 years.

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