Ovarian Stimulation in India: Where Hope Meets Advanced Fertility

Ovarian stimulation

One of the important components of assisted reproductive technologies (ART), or in vitro fertilization (IVF) and intrauterine insemination (IUI), is ovarian stimulation. It consists of taking medicine to encourage the ovaries to produce more than one egg in a cycle, instead of one egg like in a natural cycle.

Ovarian Stimulation Indication

• To augment the collection of eggs to be fertilized.
• To increase the possibility of a healthy embryo and pregnancy.
• To enable physicians to select the finest quality of eggs/embryos.

Ovarian stimulation process

The process of ovarian stimulation used in IVF and in certain IUI cycles is explained as follows:

Ovarian stimulation for IVF

• Baseline Evaluation (Day 23 of Menstrual Cycle)
• Ultrasound → to examine ovaries (no cysts, follicle count at baseline).
• Blood tests → FSH, LH, estradiol (E2).
• At the onset of stimulation, all normal.

Begin Stimulation Medications (Day 2-3)

• Marking if injectable gonadotropins (FSH, LH, or a combination of both) are initiated (on a daily basis).
• Mild stimulation may sometimes be achieved by oral agents (Clomiphene or Letrozole).
• Dose is adjusted depending on age, ovarian reserve and past response.

Follicle Monitoring (Day 5-12 of Cycle)

• Transvaginal ultrasound on a 2-3 day basis to measure follicle size.
• Blood analysis to monitor the estradiol (E2).
• Dose of the medication can be varied according to the ovarian response.

Premature Ovulation

• GnRH antagonist (Cetrotide, Ganirelix) or GnRH agonist (Lupron) is added once the follicles begin to grow.
• Purpose → do not allow follicles to release the egg at an early stage.

The Final Maturation

A trigger injection is performed when the majority of the follicles are 18-20 mm:

• hCG (Ovitrelle, Pregnyl) or
• GnRH agonist induce (high-risk cases of OHSS).
• This develops the eggs in follicles.
• The retrieval of eggs is scheduled 34 -36 hours.

Egg Retrieval

• Surgical operation of a minor nature under general anaesthesia.
• Mature eggs are collected using a thin needle directed by ultrasound.

After Retrieval

• IVF lab fertilizes eggs (with sperm of partner/donor).
• Embryos are cloned and they are subsequently transferred or frozen.

Best ovarian stimulation treatment

The Optimal Ovarian Stimulation Interventions are:

GnRH Antagonist Protocol (Very Common and Safest)

• Ideal use: The majority of women, particularly having normal ovarian reserve.

Why:

• Short duration (8–10 days).
• Lower risk of OHSS.
• More relaxed and surveyable.
• Takes daily FSH (gonadotropins) and mid cycle GnRH antagonist to inhibit premature ovulation.
• Trigger: hCG or GnRH agonist.

GnRH Agonist Long Protocol

• Indications: Use in young women with good ovarian reserve, endometriosis or more eggs are required.

Why:

• Very controlled cycle.
• Big number of eggs collected.
• Greater duration (approximately 3 4 weeks, as is initiated in the cycle previously).
• Minorly increased risk of OHSS, as compared to antagonist protocol.

Mild / Minimal Stimulation IVF

Best for:

• Women who have low ovarian reserve.
• Women who are highly susceptible to OHSS (such as PCOS).
• Patients who like fewer drugs and less money.
• Use less doses of gonadotropins + Clomiphene or Letrozole.
• Less eggs, but occasionally good eggs.
• Gentler and less stressful.

Natural Cycle IVF

• Best: Women who are unable to take medication, or have extremely low reserve and heavy stimulation will not benefit.
• Takes the natural single egg of the woman (no/little medication).
• Very poor success rates relative to stimulation but effective in some instances.

Factors Affecting Cost of ovarian stimulation in India

Ovarian stimulation in India may be very expensive or even cheap depending on various medical, personal, and institutional factors. Here are the main ones:

Stimulation Protocol Type

• Antagonist protocol (most used) - moderate price.
• Agonist long protocol - longer, involves more medications, tends to be more expensive.
• Mild stimulation or natural cycle - less expensive medicine.

Medications Used

• The largest cost factor is gonadotropins (injections of FSH, LH).
• It is more expensive in imported brands (Gonal-F, Follistim, Menopur).
• Indian generics are cheaper.
• There is additional expense in GnRH antagonists/agonists (Cetrotide, Ganirelix, Lupron).
• The cost of trigger injections (hCG or GnRH agonist) is different.
• More doses = more money (particularly in low ovarian reserve women).

Duration of Stimulation

• Usually 8–14 days.
• The more time it takes to stimulate a patient, the more injections, the more expensive it becomes.

Monitoring Requirements

• Several ultrasound examinations and blood analysis (E2, LH, Progesterone) are required.
• The increased frequency of monitoring = increased overall cost.

Age & Ovarian Reserve

• Low AMH or old women might need more dose or more stimulation time → more expensive.
• Women who are PCOS may react to a smaller number of medications → less expensive but require close attention.

Clinic / City / Doctor

• It is more expensive in a metro city (Delhi, Mumbai, Bangalore) than in a small town.
• High end IVF facilities with sophisticated labs can be more expensive than smaller facilities.

Additional Treatments

• Add-on therapies (growth hormone, DHEA, Coenzyme Q10, platelet-rich plasma) are more expensive to use.
• Genetic testing, pre-IVF tests, or more elaborate monitoring are also costly.

Package vs. Per-Cycle Charges

• There are clinics that provide full-course IVF (medications + monitoring + stimulation).
• Some others have an individual cost per scan, test and injection.

Best doctors for ovarian stimulation in India

• Dr. Kiran Arora
• Dr. Renu Raina Sehgal
• Dr. Sabhyata Gupta
• Dr. Mukta Kapila
• Dr. Anuradha Kapur

Ovarian Stimulation in India with GetWellGo

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

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• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
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