The first stage of our IVF cycle began with ovarian stimulation.
Per my doctor’s request, I went to the fertility clinic on the second day of my period for a final check up to make sure that it is safe to start our IVF treatment. The examination was quick and easy; it was only a simple ultrasound test and also the last pre-treatment evaluation, which is done to check the presence of any ovarian cysts. The absence of ovarian cysts is important because they can interfere with proper egg development during the treatment. Fortunately, there were no signs of any cysts, so nothing could hold us back from starting our fertility treatment this month. We were ready for stage 1: the ovarian stimulation.
I had to administer the hormone injections every day for five days. After that I came back to the clinic to find out how my ovaries reacted to the stimulation and how many follicles started to grow.
After the ultrasound examination, I received the stimulation protocol from my doctor. He explained that the medication plan is based on my previous test results. It is one of the reasons why we needed to do the previous blood tests. My AMH (anti-müllerian hormone) level was pretty low, so I needed a higher dosage of stimulation drugs.
But what actually is a controlled ovarian stimulation (COS)? During the ovarian stimulation phase of IVF, I used injectable fertility medication to stimulate my ovaries to produce multiple mature eggs. The injections that I used contained follicle stimulating hormone (FSH), which is necessary for ovaries to produce follicles, and luteinizing hormone (LH), which stimulates the growth of small follicles. The average length of the stimulation is 7-10 days, but in some cases it can take a couple of weeks before the medication starts working. The duration mainly depends on how the ovaries respond to the stimulation.
The right stimulation protocol highly affects the outcome of the treatment. I am sure that the process is more complicated than this, but generally speaking, if the stimulation dose is too small, none or only a small number of eggs are retrieved, and the IVF success rates decrease. On the other hand, if the dose of gonadotropins is too high, the woman is at a higher risk of hyperstimulation, also known as Ovarian Hyperstimulation Syndrome (OHSS). It is an exaggerated response to too many hormones and it can cause swelling to the ovaries, which can become painful. What is interesting about the whole stimulation process is that the same IVF protocol may work more successfully than others simply due to the different amount of available follicles. The instructions were clearly written down on the paper I received from the doctor, nevertheless, it was definitely comforting that a nurse explained everything about the injection pens and how to use them. I had to administer the first dosage of hormones to myself with the guidance of the nurse, and she said that I did it very well :) Here are some tips from the nurse:
Keep the drugs and the injectable pens in the fridge but leave them out at a room temperature for 20 minutes before administering them. Injecting a cold fluid can be unpleasant.
Try to administer the injections in the same 4 hour window every day.
To avoid skin irritation and soreness, alternate injection sites every day. One day use the right side of the belly (or the right thigh), the next day use the left side of the belly (or the left thigh).