Injectables Hormones, Clomid, and More

Written by WebMD Editorial Contributors

• Clomid or Serophene
• Injected Hormones
• Other Fertility Drugs

If you’re a woman with infertility issues, your doctor may prescribe medicine to help you get pregnant. These meds, called fertility drugs, work by causing your body to release hormones that trigger or regulate ovulation — the release of an egg from your ovary.

Even if you already use another method to boost your chances of getting pregnant, such as in vitro fertilization, fertility drugs are still an important part of treatment.

There are lots of these drugs, but here are the basics on the ones that are most commonly prescribed.

Clomiphene citrate (Clomid) has been used for more than 40 years. Your doctor may prescribe it if you’re not ovulating normally.

Clomid and Serophene, the brand names of clomiphene, are known as estrogen-blocking drugs. They cause the hypothalamus and pituitary gland, located in your brain, to release hormones called GnRH (gonadotropin-releasing hormone), FSH (follicle-stimulating hormone) and LH (luteinizing hormone). These hormones trigger your ovaries to make eggs.

These drugs are often used along with other fertility methods, like assisted reproductive techniques or artificial insemination.

How you use it: The typical starting dosage of clomiphene is 50 milligrams a day for 5 days. You usually take the first pill on the third, fourth, or fifth day after you start your period.

You can expect to start ovulating about 7 days after you’ve taken the last dose. If it doesn’t happen right away, your doctor may ask you to increase your dose by 50 milligrams a day each month, up to 150 milligrams.

After you start to ovulate, most doctors suggest taking clomiphene for no longer than 6 months. If you haven’t become pregnant after half a year, your doctor will probably prescribe a different medication or suggest that you see an infertility specialist.

How well it works: About 60% to 80% of women who take clomiphene will ovulate, and about half will be able to get pregnant. Most pregnancies happen within three cycles.

Side effects: They’re generally mild. They include hot flashes, blurred vision, nausea, bloating, and headache.

Clomid can also cause changes in your cervical mucus, which may make it harder to tell when you’re fertile and may stop sperm from getting into your uterus.

Like many fertility drugs, Clomid can raise your chance of multiple births.

If Clomid on its own doesn’t work, your doctor may recommend hormones to trigger ovulation. Some of the types are:

Human chorionic gonadotropin(hCG), such as Novarel, Ovidrel, Pregnyl, and Profasi. This medication is usually used along with other fertility drugs to trigger your ovaries to release an egg.

Follicle-stimulating hormone (FSH), such as Bravelle, Fertinex, Follistim, and Gonal-F. These drugs trigger the growth of eggs in your ovaries.

Human menopausal gonadotropin (hMG), such as Menopur, Metrodin, Pergonal, and Repronex. This drug combines FSH and LH (luteinizing hormone).

Gonadotropin-releasing hormone (GnRH), such as Factrel and Lutrepulse. This hormone triggers the release of FSH and LH from your pituitary gland, but it’s rarely prescribed in the U.S.

Gonadotropin-releasing hormone agonist (GnRH agonist), such as Lupron, Synarel, and Zoladex.

Gonadotropin-releasing hormone antagonist (GnRH antagonist), such as Antagon and Cetrotide.

These drugs aren’t pills that you swallow. Instead, you take them as shots. The dose varies, depending on how they’re being used.

Some are given beneath the skin, while others are injected into the muscle. You can get the injections on your stomach, upper arm, upper thigh, or buttocks.

You usually start taking them during your cycle, the second or third day after you see bright red blood, and continue taking them for 7 to 12 straight days. Sometimes, you may need to get injections along with Clomid that you take by mouth.

How well it works: As with clomiphene, injected hormones have a high rate of success in helping you to ovulate. Among women who do start to ovulate, as many as 50% are able to get pregnant.

Side effects: Most are mild and include problems like tenderness, infection, and blood blisters, swelling, or bruising at the injection site. There’s also a risk of a condition called ovarian hyperstimulation, which makes your ovaries grow and become tender.

The drugs also raise your chances of multiple births.

Antagon (ganirelix acetate). It’s an injected drug that can prevent early ovulation in women who are having fertility procedures. Side effects can include stomach pain, headache, and possibly the loss of your pregnancy.

Dostinex(cabergoline) and Parlodel (bromocriptine). These are medications used to lower certain hormone levels and reduce the size of a pituitary tumor that may be causing your ovulation troubles. You usually take them by mouth in small doses, but the amount can be increased if your doctor says so. Side effects include dizziness and upset stomach.

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Injectable Fertility Medications – Ovation Fertility Ovation Fertility

Treatments such as intrauterine insemination, IUI, or in vitro fertilization, IVF, may require ovarian stimulation. Ovation partner physicians often use injectable fertility medications called gonadotropins to achieve ovarian stimulation.

Two Types of Gonadotropins for Ovarian Stimulation

Two types of gonadotropins are used for ovarian stimulation:

• Follicle stimulating hormone, or FSH
• Luteinizing hormone, or LH

Normally, a woman’s pituitary gland will produce FSH and LH in a specific order and amount to cause only one follicle to grow and ovulate each month. However, when a patient receives injectable fertility medications, several follicles may grow and ovulate each month.

To Know: Two Different Classes of Gonadotropins

Gonadotropins made from recombinant DNA technology – Most Ovation partner physicians prefer to use this class of injectable fertility medications, which includes Gonal-F and Follistim.

Gonadotropins made from the purified urine of postmenopausal women – Some examples of medication from this class include Menopur and Repronex.

Gonadotropin Therapy: Daily Injections Monitored via Ultrasound

Before the patient begins injectable fertility medications, she will come to the office for an ultrasound at the start of her menstrual cycle.

• If the ultrasound does not show any cysts on her ovaries, her physician will ask her to start taking a daily dose of the injectable hormone.
• She will inject herself under the skin using a small needle; it is relatively painless.

While she takes the injectable fertility medication, her fertility doctor will monitor her using vaginal ultrasounds every two to three days as her follicles mature.

• When the ultrasound shows that the largest follicles are mature, the physician will administer a “trigger shot” — an injection of hCG or Ovidrel. This injection will mature the follicles and cause ovulation to occur.
• Intrauterine insemination can be performed in the two days following the injection.
• In an IVF cycle, eggs are retrieved from the ovaries about 36 hours after the hCG/Ovidrel “trigger” shot.

Gonadotropins Even More Successful than Clomid in Ovarian Stimulation

Because they commonly cause multiple follicles to develop, gonadotropins typically produce better pregnancy rates than Clomid when combined with IUI.

Patients may experience side effects when taking gonadotropins. These side effects include bloating, cysts, pregnancies with multiples, and sometimes a very rare condition known as ovarian hyperstimulation syndrome. However, Ovation partner physicians carefully monitor patients to keep the risk of side effects low.

Injectable fertility medications can provide ovarian stimulation in patients who suffer from numerous causes of infertility. If you have any questions about injectable fertility medications, please contact us.

Preparations for ovulation stimulation: gonal and puregon

Aimed clinic uses the latest generation combined laser for embryo hatching. Women of older reproductive age have a high percentage of embryo implantation

The most common cause of female infertility is hormonal problems. Therefore, hormonal drugs that act on the endocrine system are used to treat infertility.

These include:

• thyroid preparations;
• adrenal preparations;
• ovarian preparations.

Of the thyroid preparations, thyroxine has received the greatest use.

Adrenal preparations are: prednisolone , dexamethasone .

Ovarian preparations: estrogens and progesterone . Synthetic analogues of estrogen and progesterone are: norkolut , dufaston , proginova , microfollin , primolut-nor , esterlan , femoston .

This group of drugs is prescribed by a doctor when a woman has a menstrual cycle and replacement therapy is indicated.

If the problem is in the excessive production of the hormone prolactin, then parlodel is prescribed, which effectively suppresses the secretion of prolactin.

Often the cause of infertility in women is anovulation, that is, the failure of the follicle to mature. Then reception is shown: clomiphene citrate and clostilbegit . These drugs stimulate the growth and maturation of follicles.

The same group of drugs widely used in modern infertility treatment includes: puregon , gonal-f , alterpur , menopur (gonadotropins).

Puregon Stimulation

Puregon – indicated for the treatment of infertility in women, if it is caused by the absence of ovulation, as well as in polycystic ovary syndrome; in men with insufficiency of spermatogenesis; in the program of assisted reproductive technologies.

Stimulation with Gonal

Gonal-f – is prescribed for anovulation in women and polycystic ovary syndrome, as well as for spermatogenesis in men; in the program of assisted reproductive technologies.

Other drugs

Alterpur – is indicated for anovulation in women with polycystic ovary syndrome when clomiphene is not effective; for ovarian hyperstimulation (controlled), for obtaining follicles in the program of assisted reproductive technologies (in vitro, transfer of gametes, zygotes inside the fallopian tubes).

Menopur – is prescribed for infertility in women suffering from hypo- or normogonadotropic ovarian insufficiency to stimulate the growth of follicles; for ovarian hyperstimulation (controlled), for obtaining follicles in the program of assisted reproductive technologies.

Gonadotropins are an indispensable component in the treatment of infertility with IVF (in vitro fertilization). Thanks to the use of these drugs, it is possible to achieve the growth of several follicles, and in one phase of the menstrual cycle. Thus, it is possible to obtain several full-fledged eggs, from which it is possible to obtain several embryos. Several embryos, in turn, give a greater likelihood of a successful pregnancy.

Gonadotropins are used not only in the treatment of infertility in women. In case of violation of spermatogenesis (violation of the development of spermatozoa), gonadotropins are also prescribed.

Both male and female infertility are effectively treated with human chorionic gonadotropin (CG). The drugs are made from the urine of pregnant women. This group includes: pregnyl , prophasi , horagon .

Also: Treatment of male infertility: sperm aspiration for ICSI

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Infertility and artificial insemination | Ida-Tallinna Keskhaigla

The purpose of this information material is to provide the patient with information about the causes of infertility and the possibilities of artificial insemination.

Concept and types of infertility

Infertility or infertility is understood as a situation when a sexually active couple who does not use contraception fails to achieve pregnancy for at least one year. Infertility is a widespread problem that can affect up to 15% of couples. Thus, there may be about 20,000 infertile couples in Estonia.

Infertility can be primary, or primary (no previous pregnancy) and secondary, or secondary (infertility occurred after a previous pregnancy). In 30% of cases, couple infertility is due to female infertility, and another 30% of cases are due to male infertility. In the remaining 40% of cases, the causes are mutual or remain unexplained.

Modern infertility treatment offers various possibilities. The choice of a specific method of treatment depends on the type of causes of infertility, for which it is necessary to conduct an examination.

Most common causes of infertility

1. Disorders of egg maturation and release

Among the causes of female infertility, 20-30% are disorders of egg maturation and release.

Oocyte maturation is regulated by pituitary hormones: follicle stimulating hormone or FSH and luteinizing hormone or LH . The first of these causes the growth of ovarian follicles, and the second is required for the maturation of the egg and its release from the ovaries (ovulation). Follicles are fluid-filled sacs in which eggs are produced.

If the pituitary gland produces too much or too little of one of these hormones, the maturation or release of the egg is disrupted.

Problems with egg maturation and release can also be caused by malnutrition and thyroid function, as well as chronic diseases.

2. Damage to the fallopian tubes or uterine mucosa

Damage to the fallopian tubes and uterine mucosa is the number one cause of infertility in Estonia. Inflammation, endometriosis, and surgery can also damage the lining of the uterus, preventing the embryo from implanting. The eggs are located in the ovaries, where women of childbearing age mature and release (ovulate) one or two (rarely more) eggs each month. The end of the fallopian tube sends the egg released from the ovary into the lumen of the tube, where the egg is fertilized. The developing embryo moves along the fallopian tube, on the 4th day of development it reaches the uterus and on 7–9day after fertilization is fixed on the uterine mucosa.

If the fallopian tubes are blocked, the egg cannot travel down the fallopian tube and meet the spermatozoa, and therefore fertilization cannot occur. The fallopian tubes can be damaged due to inflammation caused by infections (chlamydia, gonorrhea, etc.). In addition, small adhesive changes in the pelvis can disrupt the function of the fallopian tubes, the causes of which may be operations on the caecum, genitals and abdominal organs, or endometriosis.

3. Endometriosis

Endometriosis is a disease in which tissue that resembles the lining of the uterus grows and functions outside the uterus. Endometriosis affects the ovaries and causes adhesive changes in the genitals and in the abdominal cavity. Endometriosis occurs in 1-7% of women of childbearing age. The causes of the disease remain unclear. Endometriosis is treated surgically or medically.

4. Changes in the quantity and quality of spermatozoa

Male infertility can be caused by:

• congenital developmental disorders (undescended testicles)
• hormonal disorders
• chronic inflammation of the genital tract
• infectious diseases (mumps (mumps))
• testicular vein dilatation
• chromosomal diseases (Klinefelter’s syndrome)
• disorders of the nervous system
• stress and lifestyle

Sexually transmitted diseases and cystic fibrosis due to gene mutations can damage the pathways of spermatozoa.

Male infertility can also be caused by:

• toxic factors (heavy metals, organic compounds, alcohol, tobacco, drugs and ionizing radiation)
• drugs (cytostatics, calcium antagonists, anabolic steroids and psychotropic drugs)
• injuries

Semen analysis

Male fertility can be assessed using semen analysis. In order for the semen analysis to give reliable results, the patient should refrain from:

• ejaculations (not less than two and not more than four days)
• alcohol
• sudden changes in temperature (hot sauna, bath)
• severe physical strain
• overwork

Sample given by masturbation in a private room at a fertility center. A man can also collect sperm at home. In this case, it must be brought within an hour to the fertility treatment center, keeping it at body temperature. A man must have an identity card with him.

The analysis examines the concentration of spermatozoa, their motility and appearance. It is also possible to detect signs of inflammation (as indicated by the white blood cell count in the semen) and anti-sperm antibodies (MAR-IgG test), which can affect sperm motility. Semen values ​​may change over time, so if necessary, the analysis should be repeated.

Artificial insemination

All proposed methods for the treatment of infertility have one goal – to help, if possible in a natural way, the fusion of the female egg and male sperm, increase the ability of the egg to fertilize and the possibility of embryo growth.

Methods of treatment are united under a single name – methods of artificial insemination.

Artificial insemination is intrauterine and in vitro .

Intrauterine insemination

Intrauterine insemination or insemination (IUI) is performed either with the patient’s spouse/partner sperm (AIH) or donor sperm (AID). During insemination, sperm is injected into the uterine cavity.

Indications for insemination:

• mild male infertility (problems with sperm count, motility or morphology, presence of anti-sperm antibodies)
• infertility due to pathology of the cervix
• unexplained infertility.

The condition for insemination is healthy fallopian tubes in a woman; the quantity and motility of spermatozoa in a man are also important.

The chance of pregnancy in one cycle of insemination is approximately 10-15%.

Insemination can be done during the natural menstrual cycle or after ovarian stimulation. In the latter case, ovulation is caused by hormones. The best results are achieved when intrauterine insemination is timed to coincide with ovulation induced by fertility drugs (ovarian stimulation).

Up to three follicles are sought by ovarian stimulation. For stimulation, treatment with tablets or injections is used. During stimulation, ultrasound is performed to monitor the development of the follicles.

Stimulation should be carried out under the supervision of a physician in order to avoid possible complications (development of too many follicles, i.e. hyperstimulation).

At the time of the expected ovulation, the partner’s sperm is prepared, which is introduced into the woman’s uterine cavity with the help of a thin catheter. The procedure is usually painless and does not require anesthesia.

Insemination takes 10-15 minutes. Immediately after the procedure, a woman can get up, go home and continue life as usual.

If there are serious deviations in the structure and motility of the partner’s spermatozoa, frozen sperm obtained from an anonymous donor can be used. All sperm donors are carefully screened for the most common genetic and viral diseases, as well as for all sexually transmitted diseases.

If intrauterine insemination fails, it should be repeated, maximum 3-4 times. If pregnancy still does not occur, you can continue treatment with in vitro fertilization (IVF and ICSI).

In vitro fertilization (IVF – in vitro fertilization and ICSI – intracytoplasmic sperm injection)

The common name for these methods is assisted reproductive technology (ART),

of which the two most common and effective are intracit plasmatic sperm injection (ICSI) and in vitro fertilization (IVF). With IVF and ICSI, the chance of getting pregnant after one cycle is about 25-30%. Childbirth reach 15-20% of pregnant women.

The probability of conception in women decreases after 37 years, therefore, in the case of in vitro fertilization, it is recommended to think about pregnancy until the age of 35.

The only difference between these two methods is how the egg is fertilized. In IVF, sperm are allowed to enter the egg on their own, while in ICSI, the sperm is injected directly into the egg. ICSI is performed under a microscope using special equipment. This method is used when sperm cannot penetrate the egg cell membrane. After fertilization of the egg, the embryo is transferred to the uterine cavity in the same way as in IVF.

Fertilized eggs develop in an incubator for 2-6 days and reach the stage of embryonic or blastocyst development. Then the embryo is transferred to the uterine cavity, where it can attach and develop pregnancy.

1-3 embryos or blastocysts are selected for transfer into the uterus. Embryos/blastocysts remaining after transplantation are frozen, if desired, and can be used for subsequent transplantation within seven years.

For women under the age of 40 who are insured by the Estonian Health Insurance Fund, freezing and the first 60 days of embryo storage are free of charge. After 60 days, the storage of frozen embryos will be charged in accordance with the price list of paid services of East-Tallinn Central Hospital.

Before preparing for in vitro fertilization, both women and men must undergo tests and examinations prescribed by a gynecologist or family doctor. Preparation for the procedure is outpatient, the doctor needs to be visited 5-6 times.

The IVF procedure consists of three stages and lasts 30-50 days, starting from the first day of drug administration until pregnancy is diagnosed.

Five-stage IVF and ICSI

1. Hormonal ovarian stimulation (preparatory stage of treatment) and monitoring

The purpose of the preparatory stage of treatment is to stimulate the simultaneous development of several eggs, i. e. controlled superovulation.

To increase the likelihood of pregnancy, as many eggs as possible should mature by the time of fertilization. Certain medications are used to prevent the premature release of eggs. Other drugs stimulate the development of more follicles in the ovary.

A woman is given hormonal drugs that stimulate follicle growth and ovulation. The growth of follicles is monitored by ultrasound 2-3 times during the cycle, if necessary, the dose of the drug is adjusted. Blood tests also allow you to monitor the level of hormones in the blood.

This stage of treatment lasts 10-14 days.

Basically, two types of treatment regimen are used: short or long. The attending physician decides which treatment regimen is best for the patient. In the case of a long treatment regimen, hormonal ovarian stimulation begins on the 21st-22nd day of the menstrual cycle, and the procedure itself is carried out approximately one month later. With a short scheme, ovarian stimulation is started at the beginning of the menstrual cycle (on the 2-5th day of the cycle), and the procedure is carried out approximately 2-3 weeks later.

When the diameter of the follicles exceeds 18 mm, the timing of egg collection is scheduled.

32-38 hours before the egg retrieval procedure, a woman is given a special drug prescribed by a doctor that causes the final maturation of the eggs.

2. Egg retrieval, or ovarian puncture

Egg retrieval is performed using a thin needle under ultrasound guidance (called aspiration). The doctor detects mature follicles using ultrasound, and then inserts first one needle and then another needle through the vagina into the ovary in order to suck out from all mature follicles the follicular fluid, which usually contains eggs, under ultrasound guidance using a light vacuum.

All eggs are collected from the follicular fluid and transferred to an incubator. Not every follicle contains an egg, and some follicles produce eggs that are not fertile. The collected eggs may be less than the follicles, the development of which the doctor monitored using ultrasound.

Ovarian puncture usually takes 10-30 minutes.

Anesthesia is used for anesthesia during the procedure, therefore, on the morning of the puncture, you should not eat or drink. Anesthesia is short-term and lasts exactly as long as required for the procedure.

After the puncture it is necessary to stay in the hospital for several hours for observation.

A man donates sperm on the morning of the ovarian puncture. On the day of sperm donation, a man should not be overworked; on the eve you can not drink alcohol and take medications, within 2-3 days it is necessary to refrain from sexual intercourse. All these factors affect the quality of spermatozoa.

Sperm is prepared in advance by means of the so-called “semen washing”, during which the most fertile spermatozoa are isolated.

In case of male infertility (if there are few spermatozoa or if there are violations of their mobility or appearance), the spermatozoon can be injected directly into the cytoplasm of the egg with a needle (ICSI).

On average, as a result of the IVF/ICSI procedure, 70% of eggs are fertilized.

3. Oocyte fertilization

In IVF , after puncture, the sperm comes into contact with the egg in the incubator. The next day, the eggs are examined under a microscope to determine if the sperm have fertilized the egg(s).

Developed embryos are transferred to the uterine cavity after 3-6 days or frozen for later transfer.

In ICSI , eggs are prepared for injection by checking their maturity. During a highly precise procedure carried out in the laboratory, one spermatozoon is injected directly into the egg, that is, into its cytoplasm. That is why the procedure is called intracytoplasmic sperm injection. After about 20-24 hours, the egg is checked for fertilization.

4. Development of the embryo

Immediately after the fertilization of the eggs, the laboratory begins to grow embryos.

Embryo(s) are usually transplanted between day 3 (2-4 cell embryo) and day 6 (blastocyst – about 100 cells). This allows you to track division (how the cells of the embryo divide) and the development of embryos in order to select only the most capable embryos for transplantation.

5. Embryo transfer

One to three embryos are selected for transfer into the uterine cavity. The main criteria for selecting embryos are their appearance and the rate of cell division. Selected in the laboratory, 1-3 most suitable (viable) embryos are drawn into a thin catheter with a syringe, with which the embryos are carefully inserted through the vagina and cervix directly into the uterine cavity itself.

To ensure that the catheter is in the correct location, the procedure is monitored by ultrasound through the abdominal wall.

After removal of the catheter, it is checked immediately with a microscope that no embryos remain in the catheter.

The transplant procedure may cause some discomfort, but is painless, so anesthesia is not used in this case. The transfer usually takes about 15 minutes. After that, you can immediately get up and continue your daily activities.

After IVF/ICSI

From the day after the embryo transfer, the doctor can prescribe treatment to maintain the pregnancy, if necessary.

Two weeks after the transfer of the embryo(s), the woman will have a blood test to see if she has become pregnant. With the help of ultrasound, you can see the pregnancy already on the 28th day after transplantation, when the diameter of the fetal egg is 10 mm.

The effectiveness of the procedure is influenced by many factors, including:

• the age of the woman
• cause of infertility
• sperm quality

Embryo freezing

The doctor will try to fertilize all the collected eggs, but usually only one embryo is transferred, sometimes two, very rarely three. The remaining viable embryos can be frozen, a process called cryopreservation. The remaining embryos after transplantation are stored in liquid nitrogen at -196 °C and most of them remain viable for a long time. Most embryos survive freezing and thawing. One of the advantages of freezing is that the frozen embryos can later be used for transfer without having to repeat the ovarian stimulation, egg collection and fertilization procedures.

According to the law on artificial insemination and protection of the embryo, frozen embryos can be stored for up to 7 years. During this period, if desired, they can be used for a new transplant.

Storage of frozen embryos is paid from the 61st day.

Frozen Embryo Transfer

Frozen Embryo Transfer (FET) can be used if the IVF/ICSI procedure has managed to keep the embryo frozen.

If the IVF procedure is not successful, then during any next menstrual cycle, thawed embryos can be transplanted into the uterine cavity.

Different schemes are used to prepare frozen embryos for transfer, both with and without drugs. The procedure is carried out in the same way as the stage of embryo transfer during IVF/ICSI. The readiness of the uterine mucosa for embryo transfer is monitored by 2–3 ultrasound examinations. Embryos are thawed on the day of transplantation. According to statistics, about 80% of embryos survive freezing and thawing. Even a single frozen embryo can become pregnant.

Children born from frozen embryos do not differ in development from children conceived naturally.

If, after defrosting, it turns out that the embryos are not viable, then the transfer is not carried out.

The dangers of artificial insemination

• Negative treatment outcome and resulting frustration.

In vitro fertilization has a 15-20% chance of having a baby per course of treatment.

• Multiple pregnancy which in turn is associated with an increased risk of miscarriage or preterm delivery .
• The most serious side effect is ovarian hyperstimulation syndrome (OHSS). This is a condition in which various fertility drugs stimulate the ovaries too much. It may be related to the use of hormones. The ovaries may increase in size, and excess fluid may accumulate in them. The ovaries react unpredictably actively to treatment, resulting in damage to cell membranes in the body. This is indicated by pain and swelling in the lower abdomen, bloating, tightness in the stomach and rectum, nausea, and in more severe cases, the disease can cause problems with breathing or urination. Contact your doctor immediately if you experience these symptoms. This condition usually requires treatment in a hospital. In some cases, it can even be life-threatening.
• Very rarely, the procedure may be complicated by bleeding (from the vagina or into the abdominal cavity). Such a complication can occur during the puncture of the eggs in case of damage to any blood vessel.
• Very rarely, manipulation may cause inflammation .
• Thrombotic complications are also described (because hormonal preparations are used in rather high doses). The likelihood of thrombotic complications is highest in cases of OHSS.
• In addition, artificial insemination can create other problems. Going through a course of treatment is not always easy, and success is not guaranteed. Even those who have achieved pregnancy are at risk of unsuccessful treatment – abortion, fetal death (as in the case of conception by natural means).

If possible, any side effects should be reported to the doctor immediately or to the Emergency Medicine Department of the Women’s Hospital.

Preservation of germ cells before fertility-impairing treatment or when a fertility-impairing condition occurs

The Estonian Health Insurance Fund pays for the preservation of germ cells before fertility-damaging treatment or in the event of a fertility-impairing condition for women under 35 and men under 40 who have had health insurance for at least 7 years.