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  » Infertility  »  Controlled Ovarian Hyperstimulation

What is controlled ovarian hyperstimulation?

It involves the use of some of the same medications used for induction of ovulation in women that have anovulation. These medications are used to stimulate development of multiple mature follicles and eggs in order to increase pregnancy rates with various infertility treatments.


Ultrasound of multiple follicles (black circles) in a stimulated ovary

Who should be treated with controlled ovarian hyperstimulation?

This therapy is often used as infertility treatment for infertile couples. It is usually done in conjunction with intrauterine insemination .

This treatment does not really correct any specific cause of infertility . Instead it is a "shotgun" approach to get multiple eggs and sperm together at the time of ovulation. This type of treatment has been shown to increase the monthly chances for a pregnancy as compared to timed intercourse alone.

Ovarian stimulation with insemination should not be used with very low sperm concentration or very poor sperm motility , blocked fallopian tubes , or age of the female partner over 43. This treatment is very unlikely to be effective in these situations.

Controlled ovarian hyperstimulation is also used to develop multiple mature follicles for in vitro fertilization cycles.

Details about ovarian stimulation protocols for IVF

How is controlled ovarian hyperstimulation performed?

The medication is given early in the menstrual cycle in the same manner as described for induction of ovulation . The way the medications are given are described on the pages that discuss subcutaneous FSH injections and intramuscular FSH injections .

An approximate schedule and calendar for an injectable FSH cycle

Pregnancy rates for controlled ovarian hyperstimulation

Success rates for controlled ovarian hyperstimulation with intrauterine insemination vary considerably and depend on the age of the woman , the total motile sperm count, the quality of the sperm, how long the couple has been trying to get pregnant, what the infertility factors are in the couple, etc.

Ovarian stimulation with gonadotropins (injectable FSH products like Pergonal or Follistim) plus intrauterine insemination gives pregnancy rates of about 5-12% per cycle (women 36 and younger) for unexplained infertility, as demonstrated in several published studies. Success rates are lower if the woman is over age 36 or if there is a sperm problem - male factor infertility . For women 40 and older, success rates with this form of infertility treatment are very low, and IVF should be considered as an option relatively soon.

In general, this type of treatment is considered reasonable for about 3-6 cycles (in women under 37), after which IVF is usually considered as the next step.