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Controlled Ovarian Stimulation (COS) is a crucial step in the in vitro fertilization (IVF) process. It involves the use of various medications to stimulate the ovaries to produce multiple eggs simultaneously. While the thought of injections and potential side effects may cause anxiety, understanding the drugs and protocols used can help ease your concerns.

Suppression Phase

During the suppression phase, oral contraceptive pills (birth control pills) are often used to decrease hormone production or schedule a cycle. While generally well-tolerated, potential side effects may include irregular bleeding, headaches, chest tenderness, nausea, and swelling. In rare cases, they can cause blood clots or strokes.

Stimulation Phase

The stimulation phase involves the use of gonadotropins, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), to stimulate egg growth. FSH is administered via subcutaneous injection and is usually well-tolerated. However, side effects may include fatigue, headaches, nausea, mood swings, and rarely, blood clots. Temporary weight gain due to fluid retention and mild injection site reactions may also occur.

‍Oral Medications

Clomiphene citrate (Clomid) and letrozole are oral medications that increase FSH and LH release. Clomid is generally well-tolerated, but a small percentage of people may experience dizziness and visual symptoms. Letrozole has minimal side effects compared to Clomid.

Mid-Cycle Medications

GNRH antagonists are given mid-cycle to prevent premature ovulation as follicles grow. They are well-tolerated but may cause mild injection site reactions, abdominal pain, headaches, and nausea.

GNRH Agonists

GNRH agonists, such as leuprolide acetate (Lupron), have various uses throughout the different phases. They can suppress premature ovulation or be used as part of the final trigger for egg maturation. When used for ovarian suppression, patients may experience menopausal-like side effects, such as headaches, hot flashes, and muscle aches. These side effects are rare when used as a trigger shot.

Trigger Shot

Human chorionic gonadotropin (HCG) is often prescribed as the trigger injection to complete the final maturation of developing eggs before retrieval. Side effects may include chest tenderness, bloating, and pelvic discomfort. In cases where hyperstimulation is a risk, a Lupron trigger with or without hCG might be recommended.

Personalized Protocols

Your medical team will select protocols and dosages based on factors such as age, weight, previous response to medication, blood hormone levels, and the number of follicles seen on ultrasound.

Conclusion

While the medications and protocols used in COS may seem overwhelming, understanding their purposes and potential side effects can help you feel more prepared and at ease. Remember, your medical team is there to support you throughout your fertility journey and will tailor the treatment to your unique needs.

The content on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider before making any health-related decisions or implementing any medical information shared here.