When going through an IVF cycle, you’ll quickly learn that ovarian stimulation is most commonly included as part of the process. But what does ovarian stimulation entail, and why is it helpful when trying to conceive?

Below, we walk you through the ovulation process, how stimulating your ovaries can help increase your chances of conceiving, and how IVF medications are used to create more eggs to fertilize.

6 Second Snapshot

• Ovulation occurs when a woman's body releases an egg.
• When undergoing IVF, women are prescribed fertility medications based on their fertility characteristics to stimulate the ovaries.
• The more eggs retrieved, the more it can help your chances of conceiving.

The Ovulation Process

Ovulation is when your body releases an egg. The first day you get your period (flow, not spotting) is considered the first day of your menstrual cycle or Cycle Day 1. Because most menstrual cycles typically last 28 days on average, you can ovulate anywhere from cycle day 11 to 18. The longer the menstrual cycle, the later your ovulation will be. However, don’t fret if this doesn’t sound like you, every individual is different!

During a fertility workup for women, doctors will conduct blood tests to look at the follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-müllerian hormone (AMH). These tests will help provide insight into your ovarian reserve (the remaining supply of eggs in your ovaries). The doctor will then develop a fertility treatment protocol for you based on both your personal goals and their findings.

Ovarian Stimulation

When undergoing IVF, you will be prescribed fertility medications to fit your fertility characteristics to stimulate the ovaries. The goal is to increase the number of follicles that will develop over a single cycle to help improve your chances of a pregnancy.

Medications that stimulate the growth of multiple follicles in the ovaries include:

• Oral medications like Clomid (most commonly used when undergoing an IUI cycle) and/or
• Gonadotropin injections such as Gonal-F or Menopur (commonly used for IVF). Gonal-F contains follicle stimulating hormone (FSH) and Menopur contains both follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

You will have several appointments to monitor your follicles' size during the IVF process. When the follicles get to a size that indicates the eggs are mature, the eggs are retrieved vaginally using an ultrasound-guided needle.

First, follicles are viewed using a transvaginal ultrasound, and then a small needle is inserted into the follicle to retrieve the egg. The number of eggs retrieved can vary based on how well the patient responded to the ovarian stimulation process. Any eggs retrieved that are mature would then be fertilized with the partner's or donor's sperm.

Where Does Ovarian Stimulation Fit into the IVF Process?

Every IVF protocol and timeline are different, but each cycle has the overall primary stages in common, including where the ovarian stimulation process falls. They are:

Fertility Consultation and Preparation: You'll meet with a reproductive endocrinologist before you begin any fertility treatment. They will review your medical history, any previous treatment you've done, and overall health. Depending on the fertility clinic, some initial consultations are just a conversation, while others include blood work and an ultrasound. Once you have chosen a clinic and are ready to begin your process, your IVF preparation will include blood work, fertility testing, ultrasound, and, depending on the protocol, potentially regulating your menstrual cycle.

Ovarian Stimulation and Monitoring: Now that the prep work is done, it’s time for ovarian stimulation. Most IVF cycles stimulate follicular growth with injectable hormones, injected on a daily basis. Again, the objective is to produce more eggs in a single cycle to be retrieved and fertilized to create embryos. During this process you will frequently check in at your clinic to have blood tests drawn and ultrasound measurements taken so your clinician can gauge how you are responding.

The Trigger Shot, Egg Retrieval, and Fertilization: When your hormone levels and follicle measurements have reached adequate levels, your clinician will instruct you to take your trigger shot. Your clinic will then schedule your egg retrieval for ~36 hours later and an embryologist will attempt to fertilize the eggs, creating embryos.

Embryo Transfer and Pregnancy Testing: Your embryo(s) will be graded and selected by your doctor to be transferred back into your uterus, hoping it will implant into the uterine lining. Usually 11 to 12 days after the transfer, a blood test is performed to confirm pregnancy. Alternatively, your embryos can be frozen for later dispensation.

When is Ovarian Stimulation Recommended?

A fertility doctor may recommend undergoing IVF and ovarian stimulation if you fit the below description:

• You've been diagnosed with medical issues such as polycystic ovarian syndrome (PCOS), endometriosis, blocked fallopian tubes, diminished ovarian reserve, or in a man's case, a concern with their sperm (low sperm count, etc.)
• Women who are under 35 years old and have been trying to conceive for over a year.
• Women that are over 35 years old and have been trying to conceive for more than six months.
• Women that are 40 years old or older who would like to conceive. (Remember, egg quantity and quality diminish as women age.)
• If you have a history of recurrent pregnancy loss and genetic testing is recommended.
• You or your family has a known hereditary issue that you may want to test for when pursuing IVF.

Your best first step is to speak with a reproductive endocrinologist and discuss your family-building options. Click here to find out the five things to consider when choosing a fertility clinic.