About insemination and stimulation

ART – what?

ART stands for Assisted Reproductive Treatment. This is the general term for the different fertility treatments: artificial insemination, IVF, IVF-ICSI, IVM, etc.

If spontaneous natural conception is proving difficult, various ART treatments are available to help you get pregnant.
The best method of treatment depends on the nature of your fertility problem.
The CRG doctor will perform tests to find the cause of your reduced fertility: see examinations man and woman.
Preliminary care programme and Guidance discuss the start of an ART treatment, and the professional guidance you receive at the CRG.

Apart from IVF|ICSI you can also go to the CRG for:
  • timed intercourse,
  • artificial insemination,
  • possibly combined with
  • ovulation-induction.

An ART treatment usually involves (light) ovarian stimulation. That is why we will start with this.

Timed intercourse


Sound advice

What can I do to give my treatment a greater chance of success? Read it all here.

And click Folic acid if you want to know what every woman who wants to be pregnant should know about it.

Ovarian stimulation
Treatment in detail
Follow-up of the result

Timed intercourse is based on a simple principle: if you know precisely when ovulation is going to occur, you also know when you need to have intercourse - obviously with ejaculation - to have a reasonable chance of pregnancy.
Timed intercourse (or artificial insemination) is often chosen as the primary treatment in unexplained infertility.

Ovarian stimulation      

Ovarian stimulation for timed intercourse is the same as for artificial insemination:
  • either clomiphene citrate is taken in tablet form (anti-oestrogens),
  • or gonadotrophins are given in injections.
Side effects are few in both cases:
  • anti-oestrogens can lead to a swollen abdomen, hot flushes and, exceptionally, flashing lights,
  • hormonal injections may cause mild abdominal pain.

    Taking anti-oestrogens      

    Taking clomiphene citrate (see How does this 'anti-hormone' work? ) fools the brain into thinking that there are insufficient levels of oestrogen in the system, which stimulates the production of FSH and LH. They in turn lightly stimulate the ovaries.
    If clomiphene citrate is given at the start of the menstrual cycle, it will lead to the simultaneous development of several follicles.

    Injections of gonadotrophins      

    Another option is the direct injection of hormone preparations hMG, FSH or rec-FSH, to imitate the effect of the gonadotrophins FSH and LH.
    This stimulates the ovaries to produce several eggs.
    The dosages have to be precisely determined, because we don’t want to trigger a 'super ovulation' like in IVF.
    The injections are given under the skin (subcutaneous).

    Final hCG-injection or not       
    Because both stimulation methods usually lead to a 'natural' LH peak and therefore a natural ovulation 36 to 42 hours later, the LH levels in the blood must be monitored regularly to determine when ovulation will occur.
    However, if there is no LH peak and the ultrasound shows one to maximum three follicles mature enough for fertilisation (bigger than 17mm), an injection of hCG will be administered to trigger ovulation.
    This injection is also administered subcutaneously. You can do it yourself at home, but the DPM notifies you of the exact timing.

    Treatment in detail       

    Day 1 of your cycle

    Day 1 of your cycle is the day you get up with bright red menstrual blood loss.
    If your period starts during the day or the blood only turns bright red over the course of the day, the next day applies as day 1.

    • On day 1 of your cycle you contact the DM (Daily Patient Monitoring), see Contact.
      This is the team that monitors and follows your treatment, schedules blood tests and ultrasound scans.
      You make an appointment for an ultrasound on day 12 of your cycle (or day 11 if this falls on a Sunday or public holiday).
    • Stimulation with anti-oestrogens: you take the prescribed dose every day from day 3 up to and including day 7.
    • Stimulation via injections of gonadotrophins hMG or rec-FSH: you follow your doctors' instructions regarding which medicine and on which day to start the treatment and when to stop.
    • On day 12 (or 11) you have a blood test.
    • This is followed by an ultrasound. You made the appointment for this on day one.
    • Still on day 12 you call the DPM after 4 p.m. for further instructions.

      Practical

      Read more about the where-when-and-how of blood samples during your treatment at the CRG.



    As of this point there are two possibilities:
    • either your blood analysis shows an LH-peak: this means ovulation is imminent. If so, follow the DPM's instructions precisely;
    • - if the follicle is still too small (diameter < 17 mm.) you must contact the DPM to schedule another ultrasound and (prior) blood test;
      - if the ultrasound shows at least one and a maximum of three ripe follicles, you will need to inject (or have someone inject it for you) the specified hCG dose that evening. That same evening you must have sexual intercourse and the following evening too. Between day 26 and 28, you will have a blood test to see if you are pregnant.

     

    Follow-up of the result      

    Between day 26 and 28 of your cycle - depending on the time of the LH-peak or hCG-injection - you will need to have another blood test to see if you are pregnant.
    Just like you, we hope for a positive outcome. But even if your period has started, the blood test is till recommended. From the test we can determine whether a normal ovulation occurred and if the bleeding is indeed a period. This is important to know for future treatment.

    Facilitating implantation with progesterone (if applicable)

    Depending on the situation you may be required to insert progesterone pessaries into your vagina as of the day of intercourse. Progesterone assists in the development of the lining of the womb and facilitates the process of implantation of the embryo.
    The pessaries must be inserted three times a day at regular intervals (e.g. at 8 a.m., 4 p.m. and 10 p.m.) and you must continue until the DPM tells you to stop.
    Please wash your hand before inserting the pessaries to minimise vaginal infections. Because there will inevitably be some moderate vaginal discharge as a result of the pessaries, sanitary towels are recommended.