Controlled ovarian hyperstimulation (COH) is a process in which the ovaries are stimulated by fertility medication to produce ovulatory follicle(s). Typically, a combination of oral fertility medication (clomiphine citrate) and injectible fertility hormones (follicle stimulation hormone) are used to stimulate the ovary to produce 2 mature follicles.
Each mature follicle contains 1 egg that is capable of being fertilized. In women who have irregular periods and do not normally ovulate, the goal is to produce 1 mature follicle and restore normal ovulatory function. In women who have regular menses and ovulate each month, controlled ovarian hyperstimulation is used to “superovulate” women in hopes of increasing pregnancy rates by producing 2-3 mature follicles per month.
With controlled ovarian hyperstimulation, the goal is to increase monthly fertility rates back to that of a 20 year old woman, approximately 20% per month. Multiple pregnancy rates account for 1-30% of these pregnancies, based on the age of the egg and the number of mature follicles obtained. The goal of controlled ovarian stimulation is to achieve a healthy singleton pregnancy.
During controlled ovarian hyperstimulation, ultrasound monitoring is performed in order to safely stimulate the ovaries. Intrauterine insemination (IUI) is also recommended in conjunction with controlled ovarian hyperstimulation (COH) in couples with unexplained infertility and couples affected by mild/moderate endometriosis.
The success rates of COH and IUI approximates the normal of 20% per month that is seen in fertile couples. However, the age of the woman and the fertility diagnosis can affect the success rate. If couples are not successful after 3-6 cycles of COH/IUI, a consultation is recommended to review the causes and possibly come up with a new plan.
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