Ovarian Stimulation Protocols for IVF – Process & Medications Used

By MD (gynecologist), BSc, PhD (gynecologist), BSc, MSc (embryologist), BSc, MSc (embryologist) and BA, MA (fertility counselor).
Last Update: 07/05/2019

Controlled ovarian hyperstimulation and the monitoring of the process is the first step to perform an assisted reproduction technique called in vitro fertilisation.

The purpose of ovulation induction is to achieve growth of several follicles in order to increase the number of oocytes obtained after the ovarian puncture and therefore the number of embryos obtained and the chance of achieving pregnancy.

To do this, gonadotropins and GnRH analogues or GnRH antagonists are prescribed to the woman. There are various treatment protocols that the gynaecologist should individualise to your particular case. The dose of medicines will also be individualised depending on the age of the woman, the previous cycles, the previous ovarian response etc.

Monitoring is performed by means of periodic transvaginal ultrasound. Its purpose is to control the number of developing ovarian follicles, to schedule the time of oocytes retrieval and to measure the endometrial thickness necessary to contribute to embryo implantation.

FAQs from users

Can there be any complications with the use of the Puregon Pen?

By José Antonio Duque Gallo BSc, PhD (gynecologist).

The use of the Puregon Pen carries no greater risk than any other gonadotropin.

What does IVF ovarian stimulation entail?

By Dr. Joel G. Brasch MD (gynecologist).

Ovulation induction for IVF entails administering gonadotropins with a GnRH agonist or antagonist to allow for the development of multiple eggs and prevent premature ovulation. The stimulation is monitored with blood work and ultrasounds. Hormone levels are measured with the blood work (estradiol, progesterone, LH) and the size of the follicles is measured to ascertain oocyte maturity. When a cohort of follicles are developed a trigger injection is given, either HCG or Leuprolide acetate, to start the process of ovulation. A trans vaginal oocyte retrieval is then performed 35-36 hours later.

What are the most common side effects of Puregon?

By Ana Mª Villaquirán Villalba MD, MSc (gynecologist).

Puregon is a fertility drug used for ovarian stimulation in patients who undergo reproductive cycles. Its active ingredient is follitropin beta, a hormone known as Follicle-Stimulating Hormone or FSH. It is obtained using genetic engineering at the lab (FSHr).

The most common side effects in women (1 out of 10 women) are:

  • Reactions around the injection site: redness, bruising, swelling, pain, and itching
  • Headache, pelvic pain and/or stomachache
  • Bloating
  • Ovarian Hyperstimulation Syndrome (OHSS)

These reactions are just transitory and not serious. OHSS, however, could lead to more severe complications if the egg retrieval procedure is not cancelled right after its detection. Thus, the most recommendable action in these cases is to cancel the cycle and wait until the next menstrual cycle starts, as by then OHSS will have fully disappeared.

Rare adverse reactions, those that affect 1 out of 100 women, are:

  • Breast discomforts: swelling, pain and/or breast engorgement
  • Diarrhea or constipation
  • Headache and nausea
  • Hypersensitivity reaction: skin rashes, redness, urticaria, and itching
  • Increased ovarian size
  • Ovarian cysts and/or ovarian torsion
  • Increased uterine size
  • Vaginal bleeding

One should note that, in case of noticing any of the above mentioned adverse reactions, she should visit her doctor as soon as possible.

Finally, as regards very rare reactions, that is, those that might occur in 1 out of every 1,000 women, we could mention thromboembolism or venous thrombus (PL thrombi) as consequences of severe OHSS. Both translate into the development of blood clots within blood vessels, which can lead to a heart attack in the worst-case scenario.

In males, Puregon can cause some side effects as well, including:

  • Injection site reactions: redness, bruising, swelling, pain, itching.
  • Headache
  • Acne and skin rashes
  • Gynecomastia: breast tissue swells in males
  • Testicular or epididymal cysts

Even though these side effects have been considered common, one should keep in mind that only a few studies have been conduced on males in comparison with females.

How can I prepare for IVF with donor eggs?

By Rebeca Reus BSc, MSc (embryologist).

From the medical point of view, the recipient has to get her body ready to receive the embryo that has been created using donor eggs in order to maximize the chances of implantation.

If fresh donor eggs are used, then synchronization between the cycles of the donor and the recipient is required. Inversely, this step is not needed when frozen donor eggs are used.

The recipient has to prepare her body for donor-egg IVF by means of endometrial preparation, which makes the uterus to grow its lining so that it is prepared for the embryo to implant successfully after the transfer (ET). To this end, the patient has to follow a strict drug protocol.

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Authors and contributors

Dr. Joel G. Brasch
Dr. Joel G. Brasch
Dr. Joel Brasch is the Medical Director of Chicago IVF, founded in 2005. He is board certified by the American Board of Obstetrics and Gynecology, and has over 25 years of direct experience in fertility treatment and reproductive care. He is also the Director of Mount Sinai Medical Center’s Division of Reproductive Endocrinology and Infertility. More information about Dr. Joel G. Brasch
 José Antonio Duque Gallo
José Antonio Duque Gallo
BSc, PhD
Bachelor's Degree in Medicine and Surgery from the University of Valencia. Specialist in Obstetrics & Gynecology. He has an extensive experience in the field of Human Reproduction. he has been Head of Human Reproduction Service at the Miguel Servet University Hospital of Zaragoza ans is currently the Medical Director of the GOBEST Clinic in Zaragoza. More information about José Antonio Duque Gallo
Licence: 505005367
 Neus Ferrando Gilabert
Neus Ferrando Gilabert
BSc, MSc
Bachelor's Degree in Biology from the University of Valencia (UV). Postgraduate Course in Biotechnology of Human Assisted Reproduction from the Miguel Hernández University of Elche (UMH). Experience managing Embryology and Andrology Labs at Centro Médico Manzanera (Logroño, Spain). More information about Neus Ferrando Gilabert
 Rebeca Reus
Rebeca Reus
BSc, MSc
Degree in Human Biology (Biochemistry) from the Pompeu Fabra University (UPF). Official Master's Degree in Clinical Analysis Laboratory from the UPF and Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). More information about Rebeca Reus
Adapted into english by:
 Sandra Fernández
Sandra Fernández
Fertility Counselor
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández

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