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Hormonal Treatment, Triggering Ovulation

Hormone treatment can increase the chances of pregnancy for couples who have been unable to conceive a child spontaneously. The reason for the inability to conceive is often due to hormonal imbalance. Although both men and women alike can be affected by hormonal disorders, in most cases, only women receive the hormone treatment.

The inability to conceive is often caused by an imbalance in ‘male’ sex hormones (androgens) and female sex hormones (estrogens), also known as hyperandrogenemia. In affected women, the follicles only mature to a small size (about 6-8 mm) and ovulation does not occur. There are also other hormonal causes of impaired follicle maturation. An increased concentration of prolactin hormones can also affect fertility. During pregnancy, prolactin promotes the development of the mammary glands and inhibits ovulation. Elevated prolactin levels before pregnancy can be treated with prolactin inhibitors.

The aim of hormone treatment in women is to promote egg maturation and trigger ovulation. This increases the likelihood of successful fertilisation. The success rate of each treatment cycle can vary greatly depending on the age of the woman and the extent of the underlying hormone disorder, usually ranging between 10 and 20%.

The role of sex hormones is, for example, to trigger ovulation, cause follicles to mature or allow a fertilised egg cell to nestle in the uterus. In many cases an inability to have children can be attributed to hormonal imbalances. It is often necessary to stabilise the cycle using hormone therapy. This can help women who, for example, suffer from irregular cycle, no ovulation, luteal phase defect or a Polycystic Ovary Syndrome (PCOS). In addition, it is necessary to stimulate the ovaries to produce eggs and to trigger ovulation. This can increase the chances of successful pregnancy, either naturally or through artificial insemination.

It is also important to mention the thyroid hormones. Normal thyroid levels play an important role in the likelihood of pregnancy. Hypothyroidism can be treated by regular administration of thyroid hormone preparations.


Cycle diagnostics

Before starting hormone treatment, we perform a detailed diagnosis during the menstrual cycle. During the diagnosis, the doctor checks for any hormone imbalance and monitors hormone levels, which may be too high or too low. In addition, the doctor uses ultrasound to monitor the follicular growth in the ovaries and to check whether and when ovulation occurs. This information is important to determine whether hormone treatment is necessary and which hormone preparations are most suitable for the treatment.


Commencing therapy

The treatment usually starts on the third to fifth day after the onset of menstruation. The medication can be administered either orally as tablets (Clomifene) or via injection under the skin. The injections usually contain only FSH, but occasionally a combination of FSH and LH as well and are usually injected once a day using a pen. After brief instruction, the women can also administer the injection themselves. For certain very rare hormone disorders, treatment with a hormone pump provides the best prospects for success.


Ovulation and fertilisation

From around the eighth day of the menstrual cycle, the doctor uses ultrasound and blood tests to check the course of follicular development. In some patients, ovulation occurs automatically when the largest follicle is approximately 18-20 mm in size. In other cases, ovulation must be triggered by the administration of another hormone, human chorionic gonadotropin (hCG). The doctor will then recommend the days on which sexual intercourse has the best chance of success. However, if it turns out that the sperm mobility or sperm number is significantly lower, treatment with artificial insemination will still be necessary.


Egg retrieval - OPU

If ripe follicles are found, the doctor collects mature eggs. This procedure is called puncture. This usually takes place 2-4 days after the second ultrasound. The procedure takes about 10-20 minutes and is usually performed under general anaesthesia. The sperm must be available on egg retrieval day as well. After retrieval is complete, the eggs are fertilised in the laboratory. We will know by the following day whether fertilisation was successful or not.


Embryo transfer

Embryo transfer (to the uterus) usually takes place three to five days after egg retrieval, depending on how the embryos develop. Embryo transfer does not require any anaesthesia. The procedure is quite similar to a normal pelvic exam and lasts about 10-15 minutes.


Side effects of hormone therapy

Hormone treatment is not entirely without risks and side effects. The most dangerous risk to health is hyperstimulation of the ovaries. Between 1 to 5% of women are affected by this side effect. The most common symptoms of hyperstimulation include abdominal pain and abdominal tightness. In severe cases, however, it can be life-threatening. Your gynecologist will be monitoring the whole process to make sure that this does not happen.

Hormone preparations can also cause too many eggs to mature at the same time. If these eggs are successfully fertilised, it can lead to multiple pregnancies (twins, triplets or even higher-order pregnancies).

Additionally, hormone treatment can change the conditions of the uterus. This can make the implantation of a fertilised egg more difficult or the cervical mucus may prevent the sperm from passing into the uterus. The risk of thrombosis is also slightly increased.

Finally, hormonal treatment can lead to symptoms similar to menopausal symptoms. These include hot flashes, sweating, headaches or depressive moods. It is up to you to consult your doctor and decide for yourself whether the benefits of hormone therapy outweigh the possible risks.