Stimulation

Stimulation

Stimulation

A hormone stimulation of the ovaries is performed if
  • no ovulation at all takes place,
  • ovulation is delayed or very late,
  • the luteal phase shows a “luteal insufficiency”, i.e. a shortage of the hormone progesterone
The hormone stimulation is performed either
  • by the daily injection of the hormone FSH under the abdominal skin (subcutaneously) or
  • by tablets which contain the anti-oestrogen clomiphene.  

Stimulation with FSH (injection)

  • Starts on the 3rd day of the cycle with a low dose of FSH, generally for a week, 50-60IU daily. Then comes the first ultrasound examination.
  • Depending on the follicle size, the daily injections and the subsequent ultrasound monitoring are continued. The follicle size should reach approx. 2 cm and, if possible, only one to two follicles should be present.
  • The development of the menstrual cycle hormones is monitored by appropriate hormone testing in the blood. Either ovulation takes place endogenously. In which case the ovulation hormone increases of its own accord, allowing the date of ovulation to be determined. Or ovulation is precisely determined at 36 hours after the treatment as a result of the subcutaneous injection of 5000IU of the almost identical hormone HCG. Sexual intercourse or an insemination treatment should take place within this period.
Success rate

The success rate of hormone stimulation is age-dependent and is between 10 and 20 % for each treatment cycle.

Problems

Hormone stimulation bears the risk of overreaction. A lot of follicles can form, leading to higher grade multiple births. For this reason, a precise monitoring of the stimulation cycle is necessary.

Stimulation with clomiphene (tablets)

  • Starts on the 4th or 5th day of the cycle by taking one to two tablets daily for five days
  • Ultrasound on the 12th day of the cycle;
  • Monitoring of the menstrual cycle by means of urine or hormones in the blood until the date of ovulation or the stimulation of ovulation by the subcutaneous injection of 5000IU of the hormone HCG.
Success rate

The success rate is 10 % per treatment cycle.

Problems
  • The anti-oestrogen substance can cause side effects such as hot flushes, spots before the eyes and circulatory problems to occur;
  • Formation of ovarian cysts;
  • Unfavourable, anti-oestrogen alteration of the cervix mucous, which may cause difficulties for the sperm getting into the uterine cavity. (verified by the post-coital test);
  • An anti-oestrogen effect on the uterine lining cannot be ruled out, which may possibly lead to implantation problems for the embryo.

In spite of the high level of effort compared to a tablet stimulation, we prefer the FSH stimulation. It is a significantly more natural way for stimulating the development of egg cells and has more minor side effects.