Ovarian Stimulation in IVF – Dr. Aksoy’s Guide
Ovarian Stimulation for IVF: A Complete Expert Guide to Your First Major Step
Hello, I’m Dr. Senai Aksoy. For over three decades here in Istanbul, I’ve had the privilege of guiding thousands of hopeful parents through the intricate journey of IVF. One of the very first, and most crucial, stages we navigate together is ovarian stimulation. In simple terms, ovarian stimulation is the heart of a successful IVF cycle. It’s a carefully managed process where we use fertility medications to encourage your ovaries to mature multiple eggs at once, instead of the single egg that typically develops in a natural cycle. The goal is straightforward but profound: to increase the number of high-quality eggs we can retrieve, which in turn gives us the best possible chance of creating healthy embryos and, ultimately, helping you build your family.
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Addressing Common Concerns
A lot of patients worry that this process feels unnatural or could lower their egg supply later on. I want to ease those worries right now. Each month, your body picks a few possible eggs, but in a regular cycle, only one egg becomes the main one, while the others just disappear. The drugs we give don’t make new eggs; they just save the eggs from that month that would have been wasted. We’re not making your body do something weird. Instead, we’re just helping the great eggs your body makes, so more of them can be part of your story. This is just the start, and my team and I will be with you every step of the way.
Your Personalized Path: Tailoring the Stimulation Protocol to You
The Principle of Individualized Care: Why One Size Never Fits All
After 30 years, I’ve learned one thing: everyone is different. Your body, past, and path are yours alone. That’s why we don’t have a standard IVF process here. We change the ovarian stimulation to fit you.
Before we even begin, we conduct a thorough evaluation to understand your specific needs. This includes assessing your age, your unique medical history (such as conditions like PCOS or endometriosis), and, crucially, your ovarian reserve—a measure of your remaining egg supply. We use tests like Anti-Müllerian Hormone (AMH) blood levels and an Antral Follicle Count (AFC) ultrasound to get a clear picture. This detailed information allows us to select the most appropriate protocol and precisely calculate the starting dose of medication for you. Our approach is guided by international best practices, such as the ESHRE Guidelines, which emphasize the importance of individualization to maximize effectiveness and, most importantly, ensure patient safety.
A Closer Look at Common IVF Protocols
While your plan will be unique, it will likely be based on one of several well-established protocols. Understanding the basics can help demystify the process and empower you on your journey. Here’s a breakdown of the IVF protocols we commonly use:
GnRH Antagonist Protocol
This is the go-to method for IVF these days, and there’s a good reason for it. You start getting stimulation shots close to when your period begins. After a bit, we add in another drug – a GnRH antagonist. Think of it as a security guard, stopping your body from releasing eggs too soon. This makes sure we can collect them when they’re perfectly ready. The best part? It’s super safe and really lowers the chance of Ovarian Hyperstimulation Syndrome (OHSS).
The Long Agonist Protocol
This is an older method, but we still use it sometimes when it’s the right choice. It starts with a longer down-regulation phase, where we use medicine to calm down your body’s hormone production before starting stimulation. This gives us more control over your cycle. It can be helpful if you have problems like endometriosis, or if we need to plan your cycle around your schedule.
Minimal Stimulation (Mini-IVF) / Natural Cycle IVF
A lighter touch can be better for some. Minimal stimulation uses lower doses of drugs, or sometimes just pills, to help a few eggs grow. Natural Cycle IVF means we just watch the one egg your body creates on its own, without any stimulation drugs. These are good options if you have a low egg reserve or want to use as little medicine as possible.
Protocol Comparison
| Protocol Name | How It Works (Simplified) | Typical Duration | Ideal Candidate | Primary Advantage |
|---|---|---|---|---|
| GnRH Antagonist | Stimulation starts early; a second medication is added mid-cycle to prevent early ovulation. | ~10–14 days | Most patients, especially those at risk for over-response (high responders). | Lower risk of OHSS, shorter duration, fewer injections. |
| Long Agonist | A 2-week “down-regulation” phase quiets natural hormones before stimulation begins. | ~3–4 weeks | Patients requiring precise cycle control or those with conditions like endometriosis. | Excellent control over follicle growth and timing. |
| Minimal Stimulation | Uses very low doses of injectable medication or oral tablets to mature a few eggs. | ~10–14 days | Poor responders, those preferring low medication, or to reduce costs. | Fewer injections, lower medication cost, reduced side effects. |
Getting Started with Stimulation: A Simple Guide
Step 1: Initial Check-Up (Day 2-3 of Your Cycle)
We’ll start on day two or three of your period. You’ll visit the clinic for a quick ultrasound, and sometimes we’ll do a blood test.
Step 2: Daily Shots Begin
You’ll begin daily shots of gonadotropins (FSH). The needles are tiny, and our nurses will show you everything you need to know.
Step 3: Careful Tracking
We use ultrasounds and blood tests to keep a close watch and adjust your medication as needed.
Step 4: The Trigger Shot—Timing Matters
When your follicles are about 18–20 mm, you’ll get another shot at a specific time. This helps the eggs mature. We’ll then retrieve the eggs exactly 36 hours later.
Step 5: Getting Ready for Egg Retrieval
After the trigger shot, your body will be ready for egg retrieval.
The Human Experience: What to Expect
Common Physical Sensations
- Bloating & Pelvic Fullness
- Mild Cramping
- Breast Tenderness
- Injection Site Reactions
Emotional Landscape
- Mood swings, irritability, and fatigue are common.
Comfort Tips
- Stay hydrated
- Eat balanced meals
- Gentle exercise
- Use your support system
Our Foremost Priority: Your Safety and Well-being
Understanding OHSS
- Rare (<1%) with modern monitoring
- Mild: bloating, nausea, mild pain
- Severe: rapid weight gain, severe pain, shortness of breath
Prevention Strategies
- Individualized dosing
- Antagonist protocol
- GnRH agonist trigger (Lupron)
- “Freeze-All” strategy for safety → Post-embryo transfer care
FAQs
Are the injections painful?
Mostly manageable, described as a “pinch.”
How long does stimulation last?
8–14 days, depending on response.
Can I exercise?
Gentle activity yes, strenuous activity no.
Does it use up my eggs faster?
No—medications rescue eggs that would otherwise be lost.
What are my risks of OHSS?
<1%, with strong prevention measures in place.
Your Journey, Our Mission
Ovarian stimulation is the start of your IVF . It’s where science meets nature, and we use our experience and tech to guide you. We really care about what you need. From the first shot to getting ready for embryo transfer, we want to keep things safe, comfy, and working well.
Want to learn more or get started? Come chat with my team.
Important Information
The info in this article is for general knowledge only and doesn’t replace medical advice. Talk to your doctor about any health questions or worries.
This article has been reviewed and medically approved by Dr. Senai AKSOY.
Last Updated: September 24, 2025
Reference
European Society of Human Reproduction and Embryology. (2024). Guideline: Ovarian Stimulation in IVF/ICSI. ESHRE. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Ovarian-Stimulation-in-IVF-ICSI
Contact us at [email protected] or call +90 507 380 28 05 for a personalised consultation. Please note: Egg donation, sperm donation, and surrogacy are prohibited in Turkey and not available at our clinic.