Controlled ovarian hyperstimulation

Controlled Ovarian Hyperstimulation (COH) is a medical procedure used in assisted reproductive technology (ART), particularly in in vitro fertilization (IVF) and intrauterine insemination (IUI). It involves the use of medications to induce the ovaries to produce multiple follicles, each potentially containing an oocyte (egg), to increase the chances of pregnancy.

Overview

Controlled ovarian hyperstimulation aims to stimulate the ovaries to produce more than the single egg that typically develops in a natural menstrual cycle. This is achieved through the administration of fertility drugs, which can include Gonadotropins, Clomiphene citrate, and Gonadotropin-releasing hormone (GnRH) agonists and antagonists. The process is carefully monitored through ultrasound and blood tests to adjust medication dosage and to determine the optimal time for egg retrieval or insemination.

Indications

COH is indicated for several fertility issues, including:

• Ovulatory dysfunction or anovulation
• Male factor infertility, when combined with IUI
• Unexplained infertility
• To collect multiple eggs for IVF or for egg freezing

Procedure

The COH process typically follows these steps:

1. Pre-treatment evaluation: Includes baseline ultrasound and possibly blood tests to assess ovarian reserve and overall reproductive health.
2. Stimulation phase: Administration of fertility drugs to stimulate the ovaries. The type and dosage of medication are tailored to the individual's response.
3. Monitoring: Frequent ultrasound and blood tests to monitor the development of follicles and hormone levels.
4. Trigger shot: When the follicles are mature, a final injection (hCG or a GnRH agonist) is given to finalize egg maturation.
5. Egg retrieval or insemination: For IVF, eggs are retrieved from the ovaries. For IUI, sperm is inseminated into the uterus.

Risks and Complications

While COH is generally safe, it carries risks, including:

• Ovarian hyperstimulation syndrome (OHSS)
• Multiple pregnancies
• Ovarian torsion
• Emotional and physical stress

Conclusion

Controlled ovarian hyperstimulation is a cornerstone of assisted reproductive technology, offering hope to many individuals and couples facing infertility. However, it is important for patients to fully understand the procedure, its risks, and its success rates in consultation with their healthcare provider.

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  Nomogram for FSH dosage by AFC

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  Nomogram for FSH dosage by AMH