NEWS & KNOWLEDGE

Why Ovarian Stimulation Should Begin No Later Than Day 3 of the Menstrual Cycle

          For women undergoing ovarian stimulation in preparation for oocyte cryopreservation or assisted reproductive techniques such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), hormonal medications are administered to stimulate the development of multiple oocytes simultaneously. Typically, the stimulation process involves hormone administration over a period of 8–12 days. Following this, an ovulation trigger injection is given approximately 34–36 hours prior to oocyte retrieval, after which the mature oocytes are either frozen or used for ICSI procedures.

Why Start Stimulation No Later Than Day 3?

          Initiating ovarian stimulation on days 2–3 of the menstrual cycle (with day 1 being the first day of menstruation) is a standard and widely accepted clinical practice. This approach targets the early cohort of antral follicles to ensure synchronized growth and development. Delaying stimulation beyond day 3 allows natural follicular selection to occur, whereby dominant follicles are selected for continued growth, and the remaining follicles undergo atresia. This reduces the number of recruitable follicles and can impair synchronization and yield.

Benefits of Initiating Stimulation on or Before Day 3

          Administering exogenous gonadotropins during this early phase promotes the simultaneous growth of multiple antral follicles. Consequently, initiating stimulation by day 3 maximizes the likelihood of obtaining oocytes that are uniform in size and maturation status, facilitating optimal timing and efficiency during retrieval.

Pre-Stimulation Self-Care Recommendations

• Adequate Rest:

Sufficient sleep is essential for women preparing for ovarian stimulation. It is recommended to sleep 6–8 hours per night, ideally before 10:00 PM, to optimize hormonal regulation and overall physiological function.

• Avoid Alcohol and Smoking:

Exposure to harmful substances such as alcohol and tobacco can disrupt hormonal balance and reproductive function, negatively affecting oocyte quality and ovulatory mechanisms.

• Stress Reduction:

Psychological stress elevates cortisol levels, which can interfere with the endocrine system and impair the production and secretion of reproductive hormones. Therefore, mental relaxation is crucial.

• Moderate Exercise:

Engage in light-to-moderate physical activity 2–3 times per week. Avoid high-impact or strenuous activities such as abdominal strain, heavy lifting, running, or jumping, as these may increase the risk of ovarian torsion.

• Balanced Nutrition:

A well-rounded diet with all five food groups is important, emphasizing high-quality protein intake—ideally twice the individual’s body weight in grams per day. Include green leafy vegetables, fruits, and whole grains to support cellular development and enhance oocyte quality.

By Assoc.Prof. Matchuporn Sukprasert

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