Ovarian stimulation is recommended for women experiencing:

1. Gonadotropins (FSH & hMG):

   These are injectable fertility hormones that directly stimulate the ovaries to produce multiple eggs

   • Follicle-Stimulating Hormone (FSH):Recombinant FSH (rFSH) such as Gonal-F® or Follistim® is commonly used.
   • Human Menopausal Gonadotropin (hMG):A combination of FSH and Luteinizing Hormone (LH), such as Menopur®, is prescribed when LH support is needed.
2. Oral Ovulation Induction Medications:

   For women with mild ovulatory dysfunction, oral medications may be used as first-line treatment.

   • Clomiphene Citrate (Clomid®):Stimulates ovulation by blocking estrogen receptors, prompting increased FSH release.
   • Letrozole (Femara®):An aromatase inhibitor that lowers estrogen levels, increasing FSH production naturally. Often used in PCOS patients sas it carries a lower risk of multiple pregnancies compared to Clomid.
3. GnRH Agonists & Antagonists:

   These medications prevent premature ovulation, allowing better control over egg maturation.

   • GnRH Agonists (Long Protocol):Examples include Lupron®, which first suppresses and then stimulates the ovaries.
   • GnRH Antagonists (Short Protocol):Drugs like Cetrotide® or Ganirelix act faster to prevent an early LH surge.
4. Trigger Injection (Final Maturation Induction):

   Once follicles reach 18–22mm in size, an HCG (Human Chorionic Gonadotropin) injection or a GnRH agonist is administered to trigger final egg maturation before retrieval.

1. Long Protocol (GnRH Agonist Protocol)
• Used for women with normal ovarian reserve.
• Suppresses natural hormones before starting gonadotropins for controlled stimulation.
• Reduces the risk of premature ovulation but requires a longer treatment duration.
2. Short Protocol (GnRH Antagonist Protocol)
• Common in older women or poor responders in previous IVF cycles.
• Requires fewer injections than the long protocol.
• Helps prevent Ovarian Hyperstimulation Syndrome (OHSS) in high-risk patients.
3. Mild Stimulation Protocol (Mini-IVF)
• Uses low-dose hormones to retrieve fewer but high-quality eggs.
• Suitable for women concerned about side effects or cost.
• Reduces the risk of OHSS and excessive follicle recruitment.
4. Natural Cycle IVF (No Stimulation)
• No hormonal stimulation – relies on the body’s natural ovulation.
• Best for women with good ovarian function but who prefer a minimal intervention approach.

COH is regarded as an additional aid for those who are using IUI, IVF, etc. to try to get pregnant. The likelihood of conception is thought to rise if COH is followed by an IUI technique.Although the likelihood of becoming pregnant declines with age, COH combined with IUI or an IVF cycle has been used to successfully conceive in women who are past the prime of pregnancy.