Hormone stimulation is used for couples where the female’s ovulation is rare or non-existent. Missing ovulations cause irregular menstrual periods occurring at several months’ interval and are often seen in females with polycystic ovaries, ie fluid-filled cysts in the ovaries. These females often have an excessive amount of small, immature eggs that can be stimulated to growth through hormone stimulation, following which the couple must have intercourse within a given time period.

First consultation with couples being treated with hormone stimulation

At this first, non-binding consultation, we will take case notes on both of you, inform you of the treatment and hear your wishes and expectations for the treatment.

If you have previously undergone hormone stimulation in another fertility clinic, either public or private, it would be helpful if you could obtain a copy of previous case notes, including the result of a possible semen analysis and bring this documentation to our talk.

If the male’s semen has not been examined earlier, or it is some time ago, it might be a good idea to have a semen analysis made on the same day when you come to the consultation. If this is the case, the semen sample must be handed in 1.5 hour prior to the consultation.

Subsequently, an ultrasound scan will be made of the uterus and ovaries, and we will draw up a plan for your treatment. The female will be given prescriptions for medication to be taken during the treatment and she will be instructed in the technique of administering hormone injections.

Registering for hormone treatment

In order to register for treatment, you must have a menstrual period, which is either achieved after oral contraceptives for 21 days or Provera treatment for 10 days.

When your menstrual period starts, you must call the fertility clinic at tel: +4576 24 50 20 on all weekdays between 9.15-12.00 a.m. and 12.30-2.30 p.m. and make an appointment for an ultrasound scan of the ovaries, which is performed around Cycle Day 9-10.

If your menstrual bleed starts during the weekend, you must call us on one of the first days shortly thereafter.

Treatment

At the first consultation, you were given a prescription for Pergotime tablets. You must take 1 tablet twice a day for 5 days from menstrual Period Day 3 and until Period Day 7. Pergotime stimulates the pituitary gland to enhance stimulation of the ovaries.

Ultrasound scan

On Cycle Day 9-10, transvaginal ultrasound is performed to assess the number of follicles and their size.

Sometimes you will have to appear for one or several control visits before the follicles have the right size. When the follicles have the right size of approximately 18mm, you will be given an injection containing an ovulating hormone (Ovitrelle) and approximately 36 hours later, you should have intercourse.

If the female fails to produce any follicles after having been treated with Pergotime tablets for 5 days, the tablets must be taken for 10 days the next time.

If no follicles are produced at this treatment either, stimulation will be performed through daily hormone injections of the follicle stimulating hormone FSH. The day after the menstrual period has started, an ultrasound scan is performed to see if the conditions required for subsequent hormone therapy are present. Following this, daily injections are administered and scans performed in the process to assess the number of mature follicles. The number of stimulation days needed to achieve a mature follicle varies from one female to the other and from time to time.

The purpose of hormone stimulation is that one to two and a maximum of three follicles mature. If more than three follicles are produced, the risk of multiple pregnancies will increase, and treatment therefore be interrupted in the current cycle.

Pregnancy test

A pregnancy test kit will be provided by the clinic, with the test having to be made from early morning urine approximately 16 days after intercourse. Please call the fertility clinic and inform us of the result. If the pregnancy test is positive, you will be given an appointment for an ultrasound scan approximately 3-4 weeks later. The pregnancy test must always be collected, even if menstrual bleeding has appeared, as this is not uncommon in a pregnancy. This would normally require additional scans.

If the pregnancy test is negative, you may commence treatment immediately again. You need therefore not pause in between treatments.

Side effects

Pergotime may cause side effects in the form of hot flushes, headache, nervousness, insomnia, and fatigue, and in very rare cases blurred vision, which all disappear once you stop taking the medication.

FSH (Gonal-f, Menopur og Puregon) may give you the feeling of a bloated stomach, abdominal pressure and headache. Ovitrelle may give pregnancy symptoms such as fatigue and nausea.

Adverse drug reactions

Some women produce more follicles than the intended one to two, maximum three. In these cases, it might be necessary to cancel treatment and prohibit intercourse in order to avoid multiple pregnancy. Another possibility is to perform a ultrasound-guided aspiration of some of the follicles to obtain the intended number.

Problematic pregnancies

If the female becomes pregnant, the risk of a miscarriage may occur in approximately 15% of the cases (same risk as in spontaneous pregnancies). Ectopic pregnancies will occur in approximately 2% of the cases. The risk of a twin pregnancy will be approximately 5-10%, and the risk of a triplet pregnancy is 2%

Contraception

Since females suffering from hormone disturbances very often suffer from PCOS, for which it is recommended to take Metformin to regulate glucose metabolism, it is important that you take a folic acid supplement during your pregnancy, as Metformin also may have an inhibitory effect on vitamin B uptake from the gastrointestinal tract. Therefore, we recommend that you take extra folic acid, ie 5 mg per day (prescription) in addition to Apovit or GraVitamin. This in order to reduce the risk of neural tube defect in the foetus. 

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