COH is specifically designed to help control when ovulation occurs, and increase the number of eggs released.

Where to begin

COH (Controlled Ovarian Hyperstimulation)

The medications that help stimulate the ovary to develop mature eggs for ovulation come in two forms: pills taken by mouth and injections. The most commonly prescribed pill to stimulate ovulation (generally of one mature egg) is clomiphene citrate. This pill generally is taken from menstrual cycle days 3 – 7.
It works in the following way:
Clomiphene is an anti-estrogen. It binds in a part of the brain called the hypothalamus, which is essential in stimulating the ovary to grow and release an egg. When clomiphene binds to estrogen receptors in the hypothalamus, it leads to an increased release of an important signaling hormone called GnRH (gonadotropin-releasing hormone). This hormone then binds to another area of the brain called the pituitary gland and leads to the release of FSH (follicle-stimulating hormone), a hormone that directly binds to cells in the ovary, leading to egg growth and maturation.

The most commonly prescribed injections that stimulate the ovary are called gonadotropins. The gonadotropins in these formulations are FSH, and in some cases, a combination of FSH and LH (luteinizing hormone). These injections are taken nightly, typically for 5 – 10 days, and act directly on the cells of the ovary to stimulate egg development. Once a follicle containing an egg reaches a mature size, another hormone injection called HCG is often given to mimic the natural LH surge that occurs at the time of ovulation. This leads to the final maturation and release of the egg.
When the follicular size reaches the target size, we program the egg retrieval process.

Why COH is Necessary

Why COH is Necessary

COH is specifically designed to help control when ovulation occurs, and increase the number of eggs released. These two factors can ultimately increase the chances of fertility when combined with other treatments. COH is not designed to treat or correct a condition that is hindering fertility. Rather, it is a way to increase the chances that other treatments will be successful.

For IVF patients, COH greatly increases the likelihood that more than one healthy egg can be harvested at once. This ultimately increases the opportunities for successful fertilization in the laboratory, and the successful introduction of an embryo into a patient’s uterus. COH medications also allow our fertility specialists to control when a patient ovulates, and to harvest eggs or introduce sperm at the proper time. This type of treatment is only for patients who are naturally producing healthy eggs and have a healthy uterus and fallopian tubes. COH can be used to help couples affected by male factor and female factor infertility.

The COH Process

The COH Process

In the first stage of COH, our specialists will inject patients with a follicle stimulating hormone, or FSH. The ovarian follicles are groups of cells that are responsible for producing a single oocyte, or female egg, at a time. FSH injections stimulate multiple follicular groups to produce multiple eggs, rather than the single egg that is produced during natural ovulation. In addition to FSH injections, our fertility specialists may also provide injections of the luteinizing hormone, which stimulates the follicle to produce estrogen and makes the uterus more hospitable to sperm and egg alike.

Once a patient’s ovarian follicles have fully matured, our specialists will provide human chorionic gonadotropin (hCG). hCG helps the ovarian follicles to release their eggs so that they can be harvested or inseminated. This usually occurs 36 to 48 hours following the injection. During follicle stimulation and egg retrieval, we will utilize ultrasound monitoring to determine the optimal time to harvest eggs or introduce sperm through IUI or artificial insemination.