Ovarian Stimulation

Process Overview
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Before the stimulation phase, you will come in for a baseline ultrasound and bloodwork to make sure that your ovaries are ready to begin the process. During the stimulation phase, you will inject yourself with gonadotropins in the thigh or abdomen.
 
The needles are short and small, and we will teach you how to do this safely and easily. You will inject yourself every day, which will encourage your ovaries to allow for multiple follicles to grow and develop.
 
You will return to the clinic on the fourth day of stimulation medications. The stimulation phase typically lasts 8 to 13 days, so most women have between 5 and 7 monitoring visits over a stimulation cycle. During these monitoring visits, you will receive a transvaginal ultrasound and blood tests that are designed to track the progress of your cycle.
 
Your estrogen level and size of your follicles will help the physician to decide your appropriate medication dose and timeline. Always keep track of how much medication you have at home. You will likely need to order refills during your stimulation cycle, especially if your dose is increased. A nurse will relay the physician’s decisions about your cycle via a message in the MyNM Patient Portal or a phone call.
 
The decision to trigger is made by the physician based on the size of your follicles and estrogen levels. You will receive a call from our nursing staff on the day you are supposed to take your trigger shot. The timing of the trigger shot is extremely important, as your retrieval should be performed 36 to 38 hours after trigger.
 
If you accidentally take your trigger shot more than 30 minutes before or after your assigned time, please notify us the next day.

FAQs: Stimulation Cycle
 
What activities should I avoid during stimulation?

You may feel bloated as your ovaries grow follicles from the stimulation medications. Weight gain of five to six pounds is not unusual and should go away within two weeks after egg retrieval.
 
You may also feel more emotional due to the hormone changes. Surround yourself with supportive friends and family during this time. If you are struggling with intense emotions, call your physician. We want to make sure that we take care of all of you—your body and your mind. This can be an intense process, and we have support available.
 
Who will I see during monitoring visits?

Morning monitoring visits include a transvaginal ultrasound by ultrasound technicians and a blood draw by a phlebotomist. These visits are purely for information gathering, and no decisions are made during monitoring.
 
We ask the ultrasound technicians to measure follicles but not to interpret these measurements, as decisions are based upon both ultrasound and blood work. If you have questions, please contact your care team via the MyNM Patient Portal or a phone call.
 
Who will communicate with me on a daily basis?

We do our best to have your primary nursing team communicate with you Monday through Friday. On weekends, the on-call nursing team will relay your results to you. Results may be relayed through the MyNM Patient Portal or via telephone.

Unintended Responses to Stimulation 

Egg freezing is not always successful, and it can cause complications that you should understand. There is no set number of eggs that you need to have to proceed with egg freezing. 

Your care is individualized based on your age and your levels of AMH, AFC and FSH, and responses may vary, including:

• A cycle does not progress appropriately: We closely monitor your cycle so that the best decisions regarding your care can be made and so that we can discuss the cancellation of the cycle with you. Retrieval is a costly process, and if we have low confidence in success for this cycle, you may choose to cancel and put your money towards a second attempt at egg freezing. 
  
  
• Insufficient follicle production: The ovary may not produce as many follicles as it is capable of in a given month. 
  
  
• Number of eggs: We don’t always get the exact number of eggs that we expect. 
  
  
• Variability in eggs retrieved versus follicles: The number of eggs retrieved does not always correlate to the number of follicles seen on ultrasounds. Some women, for reasons that are poorly understood, have empty follicles. The stimulation cycle may look good on ultrasound, but it is not until we actually perform the retrieval and aspirate each follicle from the ovary that we see empty follicles. This is understandably upsetting if it happens to you. 
  
  
• The response to stimulation may be too high: When too many follicles are produced, you may develop ovarian hyperstimulation syndrome (OHSS). This is an exaggerated response to stimulation that may result in excess fluid in the abdomen five to seven days after egg retrieval. On rare occasions, you may need to have this fluid drained from your abdomen if symptoms are severe (difficulty breathing, extreme discomfort). Occasionally, cycles can be cancelled before egg retrieval to prevent OHSS. 

To learn more about egg freezing or to schedule an appointment for a consultation, call Northwestern Medicine Center for Fertility and Reproductive Medicine at 312.695.7269.

It is extremely rare for other complications to arise, but as with any surgical procedure, there is a risk of bleeding or infection. If you do not feel well at any time or are concerned, please call your nursing team. If it’s an emergency and outside of normal business hours, call the on-call physician.

To Request an Appointment

Northwestern Medicine Fertility Center is now conveniently located in four locations: Chicago, Geneva, Highland Park, and Oakbrook Terrace.

Visit our Locations & Appointments page for more information.

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