Controlled ovarian stimulation

Controlled ovarian stimulation (COS) is a key component of assisted reproductive technologies (ART) used to enhance female fertility by stimulating the development of multiple follicles in the ovaries. In the "Dobrobut" medical network, reproductive specialists use this method as an essential step in modern infertility treatments, such as in vitro fertilization (IVF) or intrauterine insemination (IUI), as it increases the chances of successful conception.

The main goal of controlled ovarian stimulation is to stimulate the ovaries to produce several eggs in one cycle, thereby increasing the potential for successful fertilization and subsequent pregnancy. In natural cycles, typically only one follicle matures and is released; however, when using ART, having multiple eggs significantly improves the overall success rates of treatment.

Indications and Contraindications for Ovarian Stimulation

Indications:

ART: Procedures like IVF or IUI, where ovarian stimulation helps ensure the availability of sufficient mature eggs for fertilization.
Infertility: Especially in cases where the cause is unidentified, COS may be used to increase the chances of conception.
Decreased ovarian reserve: COS helps women with a reduced ovarian reserve to increase the number of follicles in one cycle.
Anovulatory disorders: Irregular ovulation or its absence.

Contraindications:

Severe ovarian hyperstimulation syndrome (OHSS).
Hormone-dependent tumors, such as certain forms of breast cancer.
Severe cardiovascular diseases, liver, and kidney diseases.
Uterine structural pathologies that may complicate pregnancy or implantation.

Diagnosis

Before beginning ovarian stimulation, thorough diagnostic evaluation is necessary to determine its suitability and personalized treatment approach. This evaluation usually includes:

Basic hormone testing: Measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) levels to assess ovarian reserve.
Transvaginal ultrasound: Used to assess ovarian structure and count antral follicles.
General health evaluation: Comprehensive examination, medical history review, and testing for infectious diseases.
Semen analysis to assess male fertility if necessary.

Preparation

Preparation for ovarian stimulation includes consultations with a reproductive specialist and other specialists, recommendations on diet, medication use, lifestyle adjustments, including cessation of smoking, alcohol, and excessive caffeine consumption.

How Ovarian Stimulation is Conducted

The process of controlled ovarian stimulation usually involves the following stages:

Monitoring: Begins with baseline ultrasound and blood tests on days 2-3 of the menstrual cycle.
Gonadotropin administration: Daily injections of gonadotropins (FSH and LH) to stimulate the ovaries.
Monitoring: Regular blood tests and ultrasounds to track follicle development and hormone levels.
Final oocyte maturation stimulation: Injection of human chorionic gonadotropin (hCG) or GnRH agonist trigger at sufficient follicular development (usually after 8-14 days of stimulation).
Egg retrieval: Approximately 36 hours after the final injection, mature eggs are retrieved from the ovaries under ultrasound guidance and local anesthesia.

Effectiveness Evaluation

Effectiveness of COS is evaluated through:

Number of mature eggs: More high-quality eggs increase the chances of successful fertilization and embryo development.
Hormonal measurements: Optimal hormone levels during stimulation indicate a good response.
Follicle development: Number and size of follicles assessed by ultrasound.
Embryo quality: Assessed after fertilization, focusing on embryo quality and development.

If changes are necessary, subsequent cycle protocols may be adjusted to improve results. The primary aim is to achieve successful pregnancy with minimal risk of side effects related to the stimulation process.

Controlled ovarian stimulation is a carefully managed process that plays a crucial role in infertility treatment.