Ovarian stimulation: what to expect, in your body and mind

In a natural cycle, only one follicle reaches maturity and releases an egg. For IVF or egg freezing, the aim is different: to retrieve several follicles at the same time in order to increase the chances of obtaining a sufficient number of mature eggs for collection.

The protocol is tailored to each woman, particularly according to her ovarian reserve and the dosage ofanti-Müllerian hormone (AMH), which give the doctor an idea of the number of follicles that could potentially be recruited. This is why protocols can vary greatly from one woman to another. There is no single way of proceeding: the protocol is above all individualised.

If you are considering preserving your fertility, you will find more details about the whole process in our guide to egg freezing.

In practical terms, ovarian stimulation always follows roughly the same course, with variations depending on the protocol chosen by your medical team.

Injections

Injections are generally given subcutaneously, often in the abdomen, at a fixed time each day. Many women feel apprehensive about this moment before experiencing it, then find that it quickly becomes routine. Some women do it themselves, while others prefer support from their partner or a nurse at first, until they feel more confident.

Monitoring

Throughout stimulation, regular blood tests and ultrasounds make it possible to monitor follicle growth and adjust doses if needed. This is often the most demanding part in terms of organisation, with closely spaced appointments, sometimes every other day.

The trigger injection

Once the follicles have reached the desired size, an injection triggers the final maturation of the eggs. The timing is precise, generally calculated to the nearest hour, as it determines when egg collection takes place.

Egg collection

Egg collection takes place around 36 hours after the trigger injection, under local or general anaesthetic depending on the centre. It is a short procedure, performed vaginally under ultrasound guidance. It may sometimes be followed by a feeling of pulling or fatigue in the hours afterwards.

This is one of the most common questions, and the answer depends on the protocol. On average, allow between 10 and 14 days of injections, from the start of stimulation to the trigger injection. Egg collection takes place 36 hours later.

Some protocols begin after a few weeks of hormonal preparation, intended in particular to synchronise the cycle. This additional time may make you feel as though you are “losing time”, even though the stimulation itself has not yet begun. Do not hesitate to ask your team for a detailed schedule from the outset. It can help you plan ahead and manage the wait more easily.

The hormones used for ovarian stimulation can cause side effects, which are usually mild and temporary[1]:

• Bloating and a feeling of heaviness in the lower abdomen, linked to follicle growth;
• Tiredness, sometimes quite pronounced towards the end of stimulation
• Breast tenderness;
• Mood changes, irritability;
• Occasional headaches;
• Minor local reactions at injection sites.

Keep in mind that experiencing these sensations does not mean that something is going wrong. They are a sign that your body is responding to treatment. The important thing is not to face these concerns alone. Your medical team is there to provide information, reassure you or adjust the protocol, if necessary.

However, if you experience severe pain, shortness of breath or rapid weight gain, contact your centre without delay, as these are signs that require prompt medical advice.

We are hearing more and more about “mild” protocols or so-called “natural” ovarian stimulation. Behind this approach is the idea of using lower doses of hormones, or even relying on the spontaneous cycle with minimal intervention, to recruit fewer follicles while aiming for better quality and fewer side effects.

This type of protocol is not suitable for every situation: it depends on your age, your ovarian reserve and the aim of your journey (IVF, freezing). It is an option to discuss with your doctor if the side effects or emotional burden of conventional protocols weigh heavily on you, but it does not replace individualised medical advice.

If a first stimulation cycle has not produced the expected results, or if several freezing cycles are planned, the question of the interval may arise.

In this respect, there is no single rule[2]: some centres suggest continuing quickly, from the following cycle; others prefer to allow one or two rest cycles for the body to recover, particularly in the event of hyperstimulation[3] or significant fatigue.

This decision is made with your medical team, based on your response to the previous treatment and how you feel. It is also a time to give yourself, if you need it, a real mental break before starting a new cycle.

Outside the medical protocol itself, in the weeks before stimulation, it is important to take care of your lifestyle. Regular sleep, a varied diet, reducing tobacco and alcohol, stress management… These fundamentals cannot replace treatments, but they can help you approach the cycle in better conditions.

It is also a good time to pay attention to your diet and improve your egg quality, drawing in particular on certain antioxidants. The coenzyme Q10 is among the most studied active ingredients in this context, alongside other nutrients such as N-acetylcysteine. Available data suggest a link between antioxidant status and the follicular environment, without it being possible to guarantee an effect on the outcome of a stimulation protocol, which depends on many factors specific to each woman[4].

It is in this spirit that Jolly Mama developed Ovo+, a supplement combining coenzyme Q10 and NAC, to take in the weeks before a cycle, as support and not as a substitute for medical follow-up. Find our full selection dedicated to this period in our fertility collection. As with any supplement, speak to your gynaecologist or midwife before starting, especially alongside a stimulation protocol.

We talk a lot about the body, but less about the emotional impact of ovarian stimulation. Between waiting for monitoring results, the mental load of fitting appointments into an already busy life, and hormones disrupted by the process, ovarian stimulation is a period when you may feel more vulnerable than usual. This is by no means a sign of weakness, but simply a response to this unique period you are going through.

Some women find support by speaking openly about their feelings and concerns with those around them. Others prefer psychological support from a professional, as some fertility centres offer.

As you will have understood, there is no right or wrong way to experience this stage. The most important thing is to remember that feeling tired or apprehensive says nothing about the outcome of your journey!