Stimulation phase goes far beyond the mental hurdle of learning to give yourself injections. The effects of these medications is systemic, a few small changes during this time can support your health, safety and potentially increase likelihood of conception through IVF.

What is the stimulation phase?

Occasionally following a period of down regulation, the stimulation phase can be considered the first stage of IVF. This phase has two goals;

Recruit and mature a lot of follicles - each of which houses one egg
Prevent those follicles from maturing to reach ovulation

What’s happening during this phase?

Recruitment!

In a natural cycle, a cohort of around 15 follicles, all housing a single precious egg, will be recruited as the brain delivers FSH, the hormone that drives follicular growth. Of this group, one of these follicles becomes the ‘dominant follicle’, and sucks up all the FSH, leaving none for the other follicles in that cohort. These unlucky ones with nothing to drive their growth, go through apoptosis, meaning they sadly, degenerate and are absorbed by the body.

Most often in an IVF protocol, the injections that you start taking on day 2 or 3 of your cycle include a synthetic version of FSH, (that’s that hormone that drives the growth of the follicles). This medication works directly on the ovaries, providing FSH for the whole cohort, meaning all the follicles grow together, each follicle housing one egg.

Handbrake on ovulation

Outside of IVF, the brain would respond to the growth and maturation of a follicle by releasing a hormone to drive ovulation. In IVF, a GnRH antagonist drug, or synthetic hormone is usually introduced around CD6 to prevent ovulation. It works by stopping the piturity gland of the brain from responding to the increasing levels of estrogen released by the follicles. In essence, it closes the brain to the signals from the ovary that the follicles are growing and need to be ovulated.

With stimulation medication, we might see somewhere between 8 and 16 follicles growing during this phase. This is about one years worth of recruitment and maturation in 10 days. Thats a lot of work. No wonder we can’t just carry on like normal.

Stimulation phase is about one years worth of recruitment and maturation in 10 days. Thats a lot of work.

Lifestyle modification 1: Adapt your exercise routine

We can still exercise and we should still exercise, but we need to adapt. Exercise ensures adequate circulation, oxygen uptake and can benefit our mental state as well. We must make sure our exercise choice;

Doesn’t draw blood away from the uterus and ovaries - avoid intense exercise and heavy weigh sets engaging the major muscle groups
Does support those increasingly heavy ovaries. During stimulation phase, the ovaries can grow from 2 to 3 cm, up to 8 to 10cm. High intensity exercise can cause the swollen ovaries to twist or flip – a medical emergency called ovarian torsion. Don’t panic, it’s fairly uncommon, but definitely one to avoid.
Not leave us in energy deficit. Don’t wear yourself out. Direct your energy where it is needed.

Good stim-phase exercise options;

Walking

Yoga – opt for a yin yoga, or if it’s not triggering a prental yoga class. Plenty of online options if you’re up for it, but don’t want to get to a studio.
Stretching
Slow steady stationary machines

Lifestyle modification 2: Acupuncture

Your acupuncturist will want to see you during your stimulation phase.

A small study compared a group two groups of women preparing for a frozen embryo transfer. The researchers found that acupuncture had a significant impact on uterine blood flow. Why is this important? Our blood is the transportation system for our hormones, nutrients, oxygen and your IVF medications. Improved circulation means increased delivery of all those important growth factors to the developing eggs and the uterine lining.

Lifestyle modification 3: Consider your supplements as you approach your trigger shot

At this point, the ovaries are in a very unnatural state. They are (hopefully) full to the brim with follicles, but have no driver for a final maturation and ovulation. This is where the trigger shot comes in. The point of the trigger injection isn’t to cause ovulation, but to provide the hormones necessary for the final maturation of the egg, the step of meiosis, when we see the 46 chromosomes in the egg halve to 23 sets of chromosomes, half the amount needed for a healthy baby - the other half being carried on the sperm.

One day before the trigger shot, it’s best to stop taking fish oil. Fish oil theoretically increases the chance of bleeding through the retrieval. A recent randomised control trial hasn’t really backed this up, but it’s not a bad idea to be more cautious.

If you’re also on supplements specifically for egg quality, you can consider coming off some of these too, however, often what is good for egg quality is beneficial for healing and may be considered right up until or after embryo transfer. Ubiquinol is a good example, but best to speak with a practitioner or your IVF specialist.

Want to know more about IVF? You can read more here

3 lifestyle modifications for your IVF stimulation phase