Ovarian stimulation

• Hormonal stimulation of the ovaries (Days 1-10): The ovaries are stimulated with the same hormones produced in the pituitary gland to produce more eggs. Physiologically, one egg cell is obtained in the process of ovulation. Hormones are in the form of injections. Tablets with or without injections can also be used. 
• Tablets can be used instead of injections in a short protocol, but all embryos are then frozen. In the long protocol, the ovaries are first blocked with injections, and then hormone stimulation begins. In situations where it is necessary to perform in vitro fertilization urgently (in women with malignant diseases before treatment with chemotherapy or radiation), the stimulation is started on any day of the cycle. Hormonal stimulation itself lasts approximately the same number of days in both the short and long protocol.
• Monitoring of follicles (Day 5-14): The first ultrasound examination is usually done on the fifth day of stimulation. During the stimulation, two to three ultrasound examinations are performed, and in some cases, laboratory analyses are also performed. The growth of the follicles is monitored and thus the maturation of the egg cells is indirectly monitored. When the follicles reach a certain size, egg aspiration is planned. Egg cells are usually not obtained from all follicles, for example if there were ten follicles, six-seven eggs will be obtained.
• Stop injection (Day 10-14): When the follicles have reached the appropriate size, an injection to induce ovulation, known as a "stop injection" or hCG injection, is given, which causes the egg to be "released" from the follicle wall and found in the follicular fluid that is aspirated from the follicle. Sometimes a GnRH agonist injection is used instead of an hCG injection.

What to expect during stimulation?

Short protocol

In the first days of stimulation in a short protocol, there are usually no side effects. At the end of the stimulation, the patient may feel tired, sleepy, bloated in the chest and stomach and experience headache. Sometimes there is redness at the injection site after the injection of drugs that block the function of the ovaries. All these side effects disappear after stopping the therapy.

Long protocol

The patient has no side effects at the beginning of therapy in the long protocol. After a few days of GnRH agonist therapy, the patient may have symptoms similar to those of menopause, as the ovaries stop producing estrogen. These can be heart pounding, insomnia, dry skin and hair, mood swings and headaches. Symptoms disappear after the start of FSH/LH stimulation. In the first days of stimulation with hormones, there are generally no side effects, while at the end of the stimulation, the same effects of the drugs as in the short protocol may occur. The complaints disappear after stopping the therapy.