Patients in treatment

Medications used to stimulate the ovaries

Synthetic FSH (Bemfola, Gonal-F; Rekovelle, Puregon) and urine-derived hMG (Menopur) contain the same hormone that the body produces in the pituitary gland, which stimulates the development of a mature follicle. Since these hormones are deliberately given in higher doses, the ovaries are stimulated to produce multiple follicles, leading to higher estrogen levels.

Known side effects
Symptoms from the ovaries may occur – bloating, tenderness, sometimes pain. Increased estrogen levels from the follicles can cause increased discharge, breast tenderness, tiredness, and nausea.
A relatively uncommon side effect is ovarian hyperstimulation syndrome (OHSS), which can occur in women with a good ovarian reserve when developing a large number of follicles. Overstimulation only develops after egg maturation has been triggered with hCG (Ovitrelle) and can be avoided by adjusting the treatment plan.

Medications that prevent the release of LH (ovulation hormone)
GnRH agonists (Suprecur, Synarela) are usually given as a nasal spray. After a short stimulation of the pituitary release of FSH/LH, this release is suppressed after 10–14 days (downregulation with the long protocol), after which ovulation is blocked during hormonal stimulation. Downregulation is verified through a blood test (estrogen should then be at a low level) or ultrasound (no growing follicles visible).

Known side effects
Hot flashes, sweating (due to low estrogen), headache, difficulty concentrating. Development of a functional ovarian cyst may occur (usually disappears over time, can also be punctured via vaginal ultrasound).

GnRH antagonists (Fyremadel, Cetrotide, Orgalutran) are given as daily injections starting on stimulation day 5–6. They effectively prevent the release of LH and thereby ovulation (short protocol).

Local side effects at the injection site are common: itching, swelling, due to histamine release. These symptoms usually subside quickly.