IVF and Fertility Specialists Clinic
Ovarian Stimulation IVF Protocols
3D ultrasound picture of multiple follicles in an ovary stimulated for IVF
Our 3D ultrasound machines calculates accurate follicle sizes
The ovaries are stimulated with the injectable FSH medications for about 7-12 days until multiple mature size follicles have developed.
What is the goal of a good in vitro fertilization ovarian stimulation?
With ovarian stimulation for in vitro fertilization, the goal is to get approximately 8 to 15 quality eggs at the egg retrieval procedure.
We do not want to have overstimulation of the ovaries which can lead to significant discomfort for the woman and in rare cases can result in ovarian hyperstimulation syndrome, OHSS.
We also do not want the ovarian stimulation to be insufficient and only give us a few eggs if we might have been able to obtain more by using higher medication doses, etc.
In vitro fertilization can be successful with a very low number of eggs retrieved, but success rates are substantially higher when more eggs are recovered.
More about the number of eggs and in vitro fertilization success rates
With the ovarian stimulation, the job of the infertility specialist doctor is to:
Ultrasound of multiple follicles (black areas) in a stimulated ovary
Yellow cursors outline a 15 mm diameter follicle
Most mature sized follicles (about 15-20 mm diameter) will give mature eggs at retrieval
Quality control throughout the entire process is very important with in vitro fertilization. One of the ways that we have improved quality control in our program is by using highly specialized ultrasound equipment.
We use a GE Voluson E8 ultrasound machine with a computer built-in that can outline and accurately measure the developing follicles.
We have found that this method is more precise and reliable as compared to the traditional method - which is usually manual measurements in two dimensions.
The computer in the machine traces the follicle borders (in three dimensions). It then calculates a volume for each one. From the volume it calculates an average diameter for each follicle (as if it was a sphere).
This technology gives us more accurate and reliable measurements than we had in the past.
Ultrasound picture shows the three planes in a volume of data from one ovary
This patient is near the end of the stimulation - numerous follicles seen in the ovary
Upper left = sagittal plane, upper right = transverse plane, lower left = coronal plane
At lower right is a 3-D view of the follicles (generated by the computer)
See below for close up views of the same images
Close-up view of the transverse plane (from the same image above)
Computer generated tracings of follicles are different colors
Close-up of a 3D view of multiple follicles in a stimulated ovary
A computer in the machine made the "rendered" image from a captured volume of data
It is obvious that follicles are not spherical in shape
Graph showing estrogen hormone levels during an IVF stimulation
Estradiol starts low and rises to 1000 to 4000 pg/ml by the time of the HCG injection
Usually, it is not difficult to get enough follicles to develop. However, sometimes the response of the ovaries is poor - and a low number of growing follicles are seen. The ability of the ovaries to stimulate well and give us numerous eggs can be predicted fairly well by an ultrasound test - the antral follicle count.
The minimum number of follicles needed to proceed with in vitro fertilization treatment depends on several factors, including their sizes, age of the woman, results of previous stimulations and the willingness of the couple (and the doctor) to proceed with egg retrieval when there will be a low number of eggs obtained.
In our experience, IVF success rates are very low with less than 3 mature follicles.
Some doctors will say that you should have at least 5 that measure 14mm or greater while others might do the egg retrieval with only one follicle. Most IVF programs in the US want a minimum of about 3-4 mature (or close to mature) follicles.
Women that are more likely to be low responders to ovarian stimulation would be those that have low antral counts, those women who are older than about 37, women with elevated FSH levels, and women with other signs of reduced ovarian reserve.
Details about antagonist IVF protocols - using Ganirelix or Cetrotide
Details about Lupron flare protocols - also called microflare
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