Hormonal stimulation: how does it go and what if it is risky for me?

Articles, News 19. August, 2018

When a couple tries to conceive, it is very important that the woman has ovulation without problems, which means releasing a mature egg from the ovary. It can meet with a sperm cell on its way to the uterus and be fertilized. What if this process does not go as it should though and the couple cannot get pregnant? If the woman has passed all the basic gyneacological examinations and the baby is still not arriving, it is time to turn to professionals. One hope can be the artificial fertilization, its inseparable part is hormonal stimulation that the woman needs to undergo. Why is it necessary and how the possible risks are solved explains the director of clinic Repromeda in Brno MUDr. Kateřina Veselá, PhD.

What is hormonal stimulation?

In case of natural cycle without problems, every month one egg in the ovary of the woman matures. If she wants to undergo an IVF treatment though, it is necessary more oocytes mature at the same time; this can be reached thanks to the hormonal stimulation which is today performed using two types of medication. “The newer and more modern method is represented by recombinant preparations that are very favorite by patients, mostly because of the efficacy and easy application by means of an injection pen. On request of the client, it is possible to choose cheaper option which is represented by urinary medications extracted from urine of menopausal women. It is a high-quality preparation, although we cannot fully guarantee the result of the stimulation as in the case of recombinant medication,” explains MUDr. Kateřina Veselá, PhD. from Repromeda.

How does the hormonal stimulation go?

Usually, the start of administration of the medication is the second or the third day of the menstrual cycle; the nurse always helps the patient with the first application and shows her everything necessary. Then the woman can continue with the administration of hormones by herself at home within 10-12 days. Despite it is a comfortable possibility at first sight, certain concerns can be connected to the whole process whether the woman can handle everything without problems. “Women can administrate the hormones by themselves at home, but the whole stimulation process is monitored by the doctor at the same time when the woman must come for an ultrasound check-up in an interval of several days. Thanks to the ultrasound the doctor always makes sure the follicles grow in a right way. Once everything is ready, the retrieval of eggs in a short-term anesthesia follows; the oocytes are fertilized that day by sperm cells and thus the embryos are created,” clarifies the whole process MUDr. Kateřina Veselá, PhD. The quality and the number of retrieved eggs is influenced by many factors but usually we gain about 8-20 eggs from the follicular fluid.

What if the hormonal stimulation is risky for me?

In some cases, the administration of hormonal medication can be risky for the woman, for example if she suffers from the syndrome of polycystic ovaries (PCOS) that directly excludes hormone application. In that case it is appropriate to use the IVM method, aka in-vitro maturation of oocytes. It goes completely without hormonal preparations or with a very low dosage. “In contradistinction of classic stimulation when mature eggs are retrieved, in case of IVM we extract immature eggs. These eggs mature within 24-48 hours in laboratory conditions under the supervision of an embryologist. The mature eggs are subsequently fertilized by micromanipulatory techniques and embryos are created, just like in a classic IVF cycle; these embryos can undergo genetic testing or be cryopreserved and used in the future,” describes MUDr. Kateřina Veselá, PhD. IVM can significantly increase the safety of the treatment with the patients at risk who, otherwise, could not undergo the artificial fertilization.