Controlled ovarian hyper stimulation is a technique used in infertility treatment by assisted reproduction involving the use of fertility medications to induce ovulation by multiple ovarian follicles. In the fertility center in Nepal/IVF Nepal, these multiple follicles can be taken out by oocyte retrieval (egg collection) for use in in vitro fertilization (IVF), or be given time to ovulate. This results to the ovulation of a larger-than-normal number of eggs, generally in the sense of at least two also known as superovulation. Controlled ovarian hyperstimulation (COH) involves the administration of oral and/or injectable medications to induce ovulation in the anovulatory infertile patient, and superovulation in the ovulatory infertile patient. The different types of medication and protocols for COH are reviewed. Pregnancy rates are higher with the injectable medications, follicle stimulation hormone (FSH) and human menopausal gonadotropins (HMG), than oral medications; however, injectable medications have a higher risk of multiple gestations, ovarian hyperstimulation syndrome, cost and monitoring.
Controlled ovarian hyper stimulation comprises three basic elements:
- Exogenous gonadotrophins to stimulate multi.follicular development.
- Cotreatment with either gonadotropin.releasing hormone (GNRH) agonist or antagonists to suppress pituitary function and prevent premature ovulation.
- Triggering of final oocyte maturation 36 to 38 hours prior to oocyte retrieval.