Preparing for Controlled Ovarian Hyperstimulation (COH)
Preparing for Controlled Ovarian Hyperstimulation (COH)
The process of controlled ovarian stimulation is a typical part of the IVF journey. Like any trip however, it requires careful planning and preparation. The steps taken before you begin promoting egg development are as important to your success as any other aspect of your treatment. Here are some of the variations.
Use of the Birth Control Pill
We virtually always start patients on a combined, low dose BCP for 7-21 days, to put their ovaries in a resting state. In fact, in older women (>40 yrs.), poor responders and women who have PCOS, we sometimes recommend that they take the BCP for 2-3 months before launching into a cycle of COH. The purpose is to suppress endogenous LH as well as promote regular turnover of the endometrial cells. Contrary to popular belief, the use of the BCP does NOT diminish ovarian response to COH with gonadotropins, provided the BCP is synchronized with a GnRHa (e.g. Lupron) for a few days before initiating the stimulation. The GnRHa causes a brief surge in FSH release by the pituitary gland, thereby setting up the recruitment of follicles to be available in the stimulation cycle ahead.
When you are cycling naturally, a rise in FSH takes place as the corpus luteum begins to atrophy a few days before menstruation. This serves as a trigger that recruits follicles taking them to the antral stage in which form they become available for the ensuing cycle. Without an FSH trigger, no follicles are recruited in which case stimulation is more likely to fail. The BCP blocks ovulation and suppresses FSH and thus if a patient comes directly off the BCP and goes on to gonadotropin stimulation, she does so without optimally recruiting follicles – an invitation for a stimulation cycle to become a disaster. A proper response to stimulation with gonadotropins requires that recruited antral follicles be available and ready by the time COH commences.
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