4th day of eco stimulation. How does ovulation stimulation work during IVF: duration, drugs, effect. How is ovulation stimulated?

What day do you start ovulation stimulation? On what day of the cycle is ovulation stimulation done? Such questions concern those women to whom the doctor has prescribed this procedure due to certain problems with the onset of pregnancy. Most often, stimulation is prescribed when a couple has problems conceiving for a long time.

Ovulation stimulation: on what day of the cycle should it be carried out?

On what day of the cycle does ovulation begin? It should be noted right away that this entirely depends on which drug the doctor has chosen for the implementation of this procedure. In addition, it also depends on the chosen ovulation stimulation scheme. As a rule, it is carried out with the help of Clostilbegit and Gonal.

What day do ovulation stimulation: Klostilbegit

Ovarian stimulation with this drug is usually started on the fifth day of a woman's monthly cycle. On the seventh and fourteenth day of the cycle, ultrasound monitoring of the growth and maturation of follicles is carried out.

Upon reaching the follicle of twenty millimeters (this occurs approximately in the middle of the menstrual cycle), the woman is given an injection of human chorionic gonadotropin. What is this hormone? Normally, it is secreted by the placenta when a woman is in an interesting position.

Its amount is constantly growing as the duration of a woman's pregnancy increases. By the twelfth week of bearing a baby, its concentration in the blood increases several thousand times, however, by the end of the third trimester, the amount of this hormone in the blood decreases significantly.

Ovulation stimulation: on what day of the cycle is it carried out when using Gonal?

The schemes for using such an ovarian stimulation agent as Gonal differ from the use of Clostilbegit for the same purpose. This drug is usually prescribed from the first to the seventh day of the cycle with regular menstruation. The duration of the ovarian stimulation course is directly dependent on the results of ultrasound monitoring and the concentration of estrogen in the woman's blood.

The drug is most often taken one to two weeks, and its dosage gradually increases. Two to three days after the last dose of Gonal, a woman is given an injection of hCG. The highest chances of conceiving a child are observed within two days after this injection. In the absence of the effectiveness of such a course, you need to repeat this therapy in the next cycle and, if necessary, increase the dosage of this drug.

On what day of stimulation does ovulation occur? As mentioned above, it depends on the drug used during the procedure.

Ovarian stimulation and IVF

For in vitro fertilization, as a rule, several mature eggs are required. From the nineteenth to the twenty-third day of the monthly cycle, the doctor injects drugs into the female body that are necessary to stimulate the ovaries.

The next stage is stimulation of the follicles with simultaneous ultrasound control. When the follicles reach the required size, a puncture is performed, after which the egg must be fertilized.

Stimulation of ovulation in the natural cycle: complications

Mention should also be made of the complications that may arise as a result of ovarian stimulation in the natural cycle. What are they represented by?

1. Ovarian hyperstimulation syndrome;
2. ectopic pregnancy;
3. Multiple pregnancy, the course of which can be significantly complicated compared to the norm.

It is worth talking more about ovarian hyperstimulation syndrome. It is important to note that in most cases, after ovarian stimulation, this syndrome is mild and does not require special treatment.

Why does this syndrome appear? This is usually due to too much follicular growth. Because of this, the ovaries greatly increase in size, cysts form in them, which in complicated cases can burst, and the fluid from them subsequently pours into the abdominal and chest cavities. Thromboembolic disorders can lead to the death of the patient.

With a mild degree of this syndrome, digestive disorders, nausea and vomiting are usually observed. If the patient is faced with a moderate severity of this syndrome, then the signs will be as follows:

1. Enlargement of the ovaries in size up to ten to twelve centimeters;
2. The accumulation of fluid in the abdominal and pleural cavities (which can only be seen with the help of ultrasound);
3. Vomit.

Finally, with a severe degree of ovarian hyperstimulation, these organs increase to more than twelve centimeters in diameter, fluid also accumulates in the pleural and abdominal cavities, blood pressure drops sharply, thrombosis may occur, and cardiac pathologies are observed.

Cycle after ovulation stimulation

Ovarian stimulation day is an important and responsible procedure for the patient, as it can help her get pregnant and finally feel the joy of motherhood. However, what will happen to the female cycle after ovulation stimulation?

Often, after the cancellation of stimulation, spontaneous pregnancy occurs. If it has not come, what will happen to the cycle? Menstruation may be delayed, and this should not be regarded as a serious pathology and a problem in the reproductive system. The fact is that a significant intervention was made in the body. Hormones are a very serious drug, most often their use for the body does not pass without a trace.

In order to minimize the dangerous consequences for the female body after ovulation stimulation, it must be remembered that it must be carried out strictly under medical supervision. It shouldn't be otherwise. Self-medication and attempts to stimulate the ovaries with the help of herbs, vitamins, and even more so hormonal preparations at home without the consent of a doctor can seriously undermine women's health and lead to irreversible consequences.

A short protocol for IVF is a specific scheme for the administration of hormonal and other drugs to stimulate ovulation. They are applied in strict order. This technique is used to correct the hormonal balance of a patient who is unable to conceive naturally. To get a favorable and expected result, it is important to combine the onset of menstruation and stimulation.

The procedure and its features by day

In this case, the puncture is performed according to when the stimulation required to prepare for the procedure was started. This is how the short protocol procedure is carried out by day:

1. The pituitary gland is blocked with the help of vitamin B9, antagonists. This happens for 3 days of menstruation up to the moment when the follicle sampling is planned.
2. From 4 to 17 days, ovarian stimulation occurs. This is done with the help of means that guarantee the optimal development of the follicles, the maturation of the egg. Such drugs are called gonadotropins.
3. Approximately 3 days before the planned egg retrieval, an hCG injection is carried out.
4. From 14 to 21 days, follicle puncture begins. On this day, a man donates sperm. The puncture is affected by the effectiveness of stimulation.
5. Fertilization of the egg, thus, occurs 4-5 days after the procedure.
6. For 5 days, the embryo is replanted, which is at the zygote stage. In order for replanting to be performed as correctly and successfully as possible, 3 embryos should be introduced into the uterus - this increases the possibility of pregnancy.
7. In order to preserve the fetal egg from the first to the 14th day, as the replanting took place, support is provided with the help of a number of important drugs, which include progesterone.
8. From the 15th day after the replanting took place, the lady should hand over a text that confirms the pregnancy. If the hCG analysis is positive, then this allows you to confirm the new position. Therefore, the procedure itself was completed successfully.
9. The IVF procedure does not take much time - only 27 to 35 days. Stimulation occurs up to 17 days.

What is the shortest protocol?

The shortest protocol starts on the 2nd day, as menstruation begins. Now such a period of time is the shortest due to the minimum number of errors. In this case, there are almost no contraindications. So the possibility of obtaining low-quality eggs is minimized. Pregnancy is confirmed in 96% of cases. The birth rate is high and miscarriages are rare.

In this very useful video, a girl shares her experience of going through a short protocol by day:

Medications for such a protocol are administered in a strict sequence. To block the pituitary gland, it is necessary to use gonadotropins such as Orgalutran. Every day, the drug is administered intravenously, intramuscularly. This is necessary in order to block the onset of ovulation if the follicles have grown to 14 mm.

But if the doctor decided not to block the pituitary gland, then it is necessary to use drugs that contain FSH. These include: Elonwu, Puregon. Such funds are administered at the very beginning of the protocol as a single injection. A significant disadvantage of such a scheme are significant violations in the growth of the endometrium.

What preparations will be required for short stimulation?

As mentioned, stimulation is performed before IVF and is carried out with or without agonists, without the use of those medications that inhibit the pituitary gland. A very short protocol differs in all important stages of fertilization, while there is no "inhibition" of the pituitary gland.

The short protocol is almost identical to the natural cycle.

This method gives all the necessary guarantees of protection against ovulation. This is because all drugs are responsible for inhibition. Such an operation is easily tolerated by women. This is due to the operational restoration of the gland. The possibility of the appearance of tumors is minimized. The very procedure of fertilization of this type lasts less time. That is why the psyche of a woman is not harmed.

A short protocol involving antagonists is usually prescribed for those women who have low anti-Müllerian hormone, if other manipulations have not brought the desired effect.

When can I start the short protocol?

The procedure starts from the 3rd to the 5th day of menstruation. In the short protocol, stimulation occurs for up to 18 days. The process itself takes no more than 35 days. The duration of this protocol is affected by the menstrual cycle. During this period, agonists are used, for example, folic acid.

The usual, approximate set of drugs used for stimulation in IVF.

IVF is performed in most clinics. This method is quite common in Russia. It is actively used by those who wish to have a baby. So every couple can become happy parents.

Tell us in the comments what set of drugs you were prescribed? Will this be your first protocol? Ask questions. Share this article on your social networks. Don't forget to rate. Thanks for visiting. Be healthy, less side effects when stimulating and may you succeed!

A woman's ovaries have a supply of follicles that she receives at birth. Every month, as a result of the maturation and rupture of the follicle, an egg is released from it. Ready for fertilization, she enters the fallopian tube. It is here that fertilization takes place, after which the egg continues its journey to the uterus. The release of the egg from the follicle (graafian vesicle) is called ovulation.

Lack of ovulation excludes the possibility of conception. In some cases, the release of the egg is provoked by medical methods. Such artificial stimulation allows women to conceive in whom pregnancy does not occur naturally.

What is artificial stimulation of the ovulation process?

The work of the reproductive system of the female body can be activated artificially. Drug exposure leads to the growth and maturation of follicles. Treatment is aimed at strengthening the functioning of the ovaries. At the same time, the production of hormones responsible for the maturation of the follicle, the formation of a healthy egg suitable for fertilization and its release from the follicle increases. In the natural state, several follicles mature in the body at once, but only one of them goes through the process to the end and produces a dominant egg.

The production of the necessary hormones occurs not only in the ovaries, but also in the pituitary gland, which is affected by the hormones of the hypothalamus. Accordingly, drugs that affect any of these organs can be used. Pituitary hormones directly affect the functioning of the ovaries, and hypothalamic hormones act on the pituitary gland, stimulating the production of hormones for the ovaries.

The effectiveness of such treatment is manifested only if the woman does not ovulate. Infertility with other causes is not affected by the procedure. Artificial stimulation of ovulation is not a harmless process at all, it can cause side reactions. In addition, ovulation is not yet a guarantee of pregnancy. In this regard, stimulation is carried out only if there are specific indications for its implementation.

Indications for the procedure

It makes sense to conduct stimulating events if a woman does not ovulate, or it occurs very rarely. The procedure is also prescribed for in vitro fertilization. In this case, it is necessary even when the cycle is not broken, and the follicles mature normally.

They also resort to the procedure when, for one reason or another, it is required to conceive 2 or 3 babies at once. Stimulation leads to the maturation of several follicles at once and their simultaneous ovulation.

If a woman is to have her ovaries removed, artificial stimulation is also often used before the operation. This allows you to get several healthy eggs that can be frozen and later used for fertilization.

Are there any contraindications for ovulation stimulation?

Such a serious effect on the body has a number of contraindications:

1. Polycystic. At the same time, several follicles mature in the body every month, but they do not break through, and ovulation does not occur. Stimulation can only enhance the process and cause significant harm to the female body.
2. You can not use the method during menopause. Theoretically, the introduction of hormones can stimulate the formation of an egg, but the pituitary gland and ovaries may not respond to the introduction of drugs. In addition, a late child, conceived at such a mature age, may be born with pathologies.
3. Hypersensitivity of the patient's body to the components of the drugs.
4. It does not make sense to stimulate ovulation in case of endometrial diseases, as well. the embryo will still not be able to gain a foothold and develop normally in the uterus.
5. The procedure is not indicated for tumor diseases of any of the female genital organs, as well as the pituitary gland, hypothalamus and thyroid gland.

How is the procedure?

Before starting ovulation stimulation, a woman needs to undergo a thorough examination. According to its results, the necessity and possibility of carrying out the procedure, possible additional measures are determined. At this stage, diseases that prevent the effective application of the technique are detected. Often, a survey of a man is required, because. with a low quality of sperm for the onset of pregnancy, a woman is prescribed additional procedures.

Preliminary examination (instrumental and laboratory)

A preliminary examination is aimed at identifying the patient's diseases, the possibility of pregnancy after stimulation, and assessing the general condition of the body. Research is divided into instrumental and laboratory.

Instrumental research methods include:

1. Consultation with a therapist to find out if a woman can give birth. In this case, the doctor prescribes the types of examination that are required for this patient.
2. An electrocardiogram is mandatory.
3. Fluorography.
4. Ultrasound examination of the pelvic organs, chest.
5. Examination of the fallopian tubes - radiography using a contrast agent, ultrasound with the introduction of saline, laparoscopic examination through punctures in the abdominal wall or perturbation - blowing the fallopian tubes with carbon dioxide. The research method is chosen by the doctor, based on the patient's condition.
6. Folliculometry - monitoring the work of the ovaries in one or more cycles using ultrasound.

Laboratory research methods include:

• general clinical blood and urine tests;
• blood tests for dangerous infectious diseases: HIV, syphilis, hepatitis;
• analyzes of smears from the cervical canal and vagina;
• tests for chlamydia, trichomoniasis, gonorrhea, mycoplasmosis, etc.;
• determination of the content of sex hormones in the blood: FSH, LH, estradiol, prolactin, testosterone.

Scheme selection

There are 3 main schemes for ovulation stimulation:

1. With the help of Clostilbegit - a dual-use drug. With a lack of estrogen in the body, an estrogenic effect occurs, with its excess, an antiestrogenic effect is observed.
2. With the help of gonadotropins - hormones produced by the pituitary gland and placenta. The drugs are injected directly into the ovary and induce the growth of multiple follicles.
3. The combined scheme involves the phased application of both methods with a decrease in the total amount of hormones administered.

Main stages

When choosing the first scheme, drugs to stimulate ovulation, such as Klostilbegit and Clomid, are taken from the 2nd day of the cycle in the form of tablets. The course lasts 5 days, the maturation of the follicles is controlled by ultrasound. Then, in the middle of the cycle, the woman is injected with human chorionic gonadotropin (HCG) to initiate the removal of the egg from the follicle.

The second ovulation stimulation scheme involves the use of gonadotropins in the form of injections. The injection is made daily at the same time, starting from 2-3 days from the beginning of menstruation. At the same time, due to the effect of the drug, the artificial development of the follicle is similar to the natural one. The process is controlled by ultrasound. At the same time, the state of the endometrium, the uniformity of the growth of follicles are evaluated, the occurrence of cysts is excluded. In the middle of the cycle, hCG is also introduced.

Stimulation according to the third scheme begins with the intake of Clostilbegit, then injections of gonadotropin are made for 5-7 days. To release the egg, hCG is administered, then sexual intercourse is necessary for 2 days. After that, progesterone is prescribed to maintain the functioning of the corpus luteum.

Methods Used

To achieve the desired pregnancy, various methods are used. In addition to using drugs to get pregnant, you can use herbs, vitamins, use folk remedies. All these methods that cause ovulation and make it possible to become pregnant have a different effect.

Tablets can not be prescribed to yourself on your own, and folk remedies are quite applicable at home. In addition, harmful consequences after them occur less frequently.

Medications

Stimulation of reproductive activity with medicines can accelerate the onset of pregnancy in an average of 50% of cases. The following are the main drugs used in medical practice:

1. Clostilbegit is the most effective remedy. Produced in the form of tablets, it has a number of contraindications. For a lifetime, the medicine can be used only in 6 cycles.
2. Letrozole is an alternative to Clostilbegit if the latter is contraindicated. The action is less long and strong, but the drug does not give side reactions.
3. Gonal is a very powerful follicle-stimulating hormone. Stimulation of ovulation with Gonal is used when other drugs have not helped. Gonal is available in the form of a powder and a syringe pen. Analogues of Gonal are drugs containing FSH Menogon and Puregon.
4. Duphaston is an analogue of progesterone produced in the body. Affects the endometrium, contributing to the onset of conception.

Traditional medicine

Stimulation of ovulation with folk remedies is quite effective and does not violate the hormonal background. To stimulate the growth of follicles, it is recommended to take an infusion of sage containing phytoestrogens and promoting the maturation of the follicle from 5 to 14 days after the start of menstruation. In the second half of the cycle, the upland uterus will help. The decoction of the herb is rich in progesterone.

Improves follicle growth and decoction of psyllium seeds. Effective for accelerating the onset of pregnancy infusions of rose petals, knotweed herbs.

Despite the high efficiency and relative safety of ovulation stimulation with folk remedies, it is impossible to use them without the consent of a doctor. Any method of stimulation is permissible only after a thorough examination.

Vitamins and special diet

There are other ways to induce pregnancy. By what means can this be done? First of all, by changing the diet, including the necessary foods and vitamins in it.

Certain food groups lead to an intensification of estrogen production. These include: hard cheeses, quail eggs, natural cow's milk (not from the store). For this purpose, apples, carrots, tomatoes and cucumbers, beans, dates and pomegranates are suitable. Pumpkin seeds, linseed oil and wheat germ are also useful. In addition to the stimulating effect, these products will saturate the body with natural vitamins and lead to its recovery.

Effective oils and mud baths

Mud treatment will help bring conception closer if the cause of trouble is an inflammatory process. Mud applications extinguish inflammation, help restore the functions of the female reproductive system. You can buy such a remedy at any pharmacy. Sanatorium treatment in places where mud is mined in its natural form will give an even more tangible result. However, this tool is very strong and has contraindications, so it can only be used in consultation with the gynecologist.

Stimulate the production of hormones baths with essential oils. For them, anise and rose, sage and basil, cypress, as well as fragrant lavender are used.

What are the consequences after the procedure?

Pregnancy after ovulation stimulation does not always occur. In addition, the technique carries serious health risks.

Follicle-stimulating hormone (FSH), which is necessarily used in treatment regimens, has a strictly defined time in the natural cycle. As soon as the result is achieved, the pituitary gland stops its production. However, in the schemes according to which stimulation is carried out, the female body receives FSH for much longer, which leads to stimulation of superovulation. This is done in order for more follicular elements to mature. With IVF, this is necessary in order to select the healthiest cells for conception.

One of the main methods of infertility treatment is drug stimulation of ovulation, the task of which is to ensure the growth and maturation of follicles to a preovulatory state. Subsequently, drugs are introduced that are the starting factor for the processes of final maturation of the oocyte and ovulation.

Artificial stimulation of ovulation in general terms

To date, many causes of infertility have been identified and continue to be clarified, options for achieving pregnancy are being developed and improved, both through controlled induction of ovulation processes and with the help of modern reproduction technologies in programs of various in vitro fertilization methods.

Stimulation of ovulation is necessary in cases where the cause of infertility is the absence of a mature egg from the ovary (), mainly if present. The latter is a polyetiological endocrine disorder caused by both hereditary causative factors and environmental factors.

Polycystic ovary syndrome is manifested by polycystic ovarian morphology, ovulatory and/or menstrual dysfunction, and symptoms of hyperandrogenism. Stimulation is carried out only after examination and exclusion of other factors of infertility, such as male and.

Controlled induction of the ovulatory process, the main drug in the scheme of which is Clomiphene citrate, or Clostilbegit (ovulation stimulation pills), can result in conception naturally, intrauterine administration of sperm () or collection of follicles through transvaginal puncture for further artificial in vitro fertilization (IVF) of oocytes . At the same time, drugs for stimulating ovulation during IVF are used basically the same as for those for the purpose of natural (or by artificial insemination) conception.

The feasibility of using traditional medicine

The literature on traditional medicine, many Internet sites and even some gynecologists give advice on dealing with infertility, which suggests the stimulation of ovulation with folk remedies.

In folk medicine, even before the development of scientifically proven methods of combating infertility, there were recommendations on the use of certain medicinal herbs and fees for this purpose, special gynecological massage, etc. The preparation of such recipes was purely empirical and did not take into account the causes of infertility.

And at present, for these purposes, for example, an extract of Tribulus terrestris, decoctions and infusions of sage, pine forest, rose petals, decoctions of Adam's root, plantain seeds, four-membered radiola leaves, knotweed grass, a mixture of aloe pulp with melted butter and honey, etc. .

Folk methods also recommend vitamins, mainly “E” and “C”, ready-made vitamin complexes with macro- and microelements, infusions of medicinal plants containing vitamins, aromatic baths or abdominal massages with essential oils of lavender, sage, cypress, basil, anise, sandalwood wood, roses, etc.

Some ovulation inducing herbs contain substances that may have some effect on infertility. However, most often the mechanism of action and the points of application in the body of the active ingredients contained in them have not been studied enough, and their dosage has not been determined.

The apparent effectiveness of their application in some cases is usually associated with chance. So, for example, if ovulation stimulation was performed with multifocal ovaries, which were erroneously diagnosed as polycystic.

Multifocal, or multifollicular, ovaries can be detected by ultrasound and represent one of the normal sonographic variants in the natural cycle on the 5th to 7th day of the menstrual period. They have a significant echographic similarity with polycystic ovaries, but differ in the normal size of the latter and a much smaller number (usually no more than 7-8) follicles.

This condition occurs with hypogonadotropic amenorrhea, and also as a physiological condition in women, especially those who take it for a long time, in girls during puberty. Often, such an echographic picture is taken for an emerging or already existing polycystic ovary syndrome and treatment is prescribed.

At the same time, multifollicular ovaries in themselves are a variant of the norm and cannot be the direct cause of infertility or menstrual irregularities. For the purposes of differential diagnosis, it is necessary to take into account the presence of general external changes (hirsutism, obesity, etc.), as well as the results of additional studies on hormones - blood levels of testosterone, luteinizing and follicle-stimulating hormones and insulin.

Drug stimulation of ovulation in polycystic ovaries

The meaning of treatment is to restore ovulatory cycles. Preparation for treatment includes an examination to exclude tubal-peritoneal and male factors as the causes of infertility. Elevated body mass and free testosterone indices, amenorrhea, enlarged ovaries are unfavorable prognostic factors for the use of the controlled induction technique.

When preparing a woman, a blood test for the content of Müller's inhibitory substance, or anti-Müllerian hormone (AMH), has a certain prognostic value. The synthesis of this hormone occurs in the granular cells of the growing follicles. It reduces their sensitivity to the influence of follicle-stimulating hormone and inhibits the growth of premordial follicles, which are a functional reserve. The latter decreases with increasing age.

AMG allows you to evaluate the functional reserve of the ovaries and decide on the advisability of ovulation stimulation, as well as differentially select and prepare women for conducting. The response of the female body to stimulation with low AMH is much worse compared to women with a normal level of this hormone.

Changing the concentration of anti-Müllerian hormone during controlled induction makes it possible to determine the degree of risk of developing hyperstimulation syndrome.

In preparation for conception, therapeutic lifestyle modifications are needed, including recommendations for a specific diet, exercise, and obesity treatment, which must be implemented before ovulation induction begins. This is due to the fact that in women with a high body mass index, androgenic hormones are produced in excess. In addition, preparation measures also include drugs such as folic acid and its derivatives, smoking cessation.

What drugs are used to stimulate ovulation?

Under the influence of one of the prescribed hormonal drugs, the growth and maturation of the dominant follicle is stimulated. Sometimes the maturation of several follicles is possible. After that, drugs are introduced that promote the release of a mature egg from the follicle and prepare the endometrium for implantation of a fertilized egg.

For these purposes, according to the developed program, the following drugs are mainly used to stimulate ovulation and prepare the endometrium:

• Clostilbegit;
• Letrozole;
• Gonal-F or Puregon;
• Human chorionic gonadotropin (hCG);
• Dydrogesterone.

How is ovulation stimulated?

The selection of the program takes into account the age of the woman, her body mass index and the presence of other factors of infertility. During induction cycles, observations are made to detect the appearance of menstrual blood in women with previous amenorrhea, laboratory studies of the average increase in luteinizing hormone in the cycle, an increase in the concentration of progesterone during the expected middle phase of luteinization, ultrasound examinations, as a rule, daily, especially from the 10th day of the cycle.

All this is necessary in order to control the response of the ovaries in terms of maturation and release of the egg or pregnancy. Ovulation is stimulated at home, but with systematic outpatient monitoring and examination.

Clostilbegit (clomiphene citrate)

Clostilbegit serves as a first line remedy. The drug, the active ingredient of which is clomiphene citrate, is available in tablets of 50 mg.

The scheme of stimulation of ovulation with Klostilbegit is as follows. The drug is taken from the 2nd to the 5th day of the natural or stimulated menstrual cycle. In the case of amenorrhea, clomiphene citrate can be started on any day. Its starting daily dose is usually 50 mg, course intake - 5 days. If there is no effect, the second scheme is used, according to which the daily dosage of Clostilbegit is already 100 mg at the same course duration.

How many times can I stimulate ovulation with clomiphene citrate?

The maximum daily dose should not exceed 150 mg of the drug. Such treatment can be carried out for no more than six cycles of expected ovulation. However, as a rule, in most cases (85%), pregnancy occurs already in the first 3-4 months after clomiphene therapy.

The mechanism of action of Clostilbegit, which is the drug of choice for polycystic ovary syndrome, is due to its combination with estrogen receptors and their blocking, resulting in (as a result of positive feedback) an increased secretion of pituitary gonadotropic hormones (follicle-stimulating and luteinizing). This, in turn, causes follicular hormonal activity with subsequent formation of the luteal body and stimulation of its activity.

Unfortunately, resistance to the drug is about 30% of women, and the effectiveness of treatment with clomiphene reaches only 70-80%, and the fertilization rate per cycle is only 22%. The effectiveness is especially low among women with very low body weight.

• decreased blood flow in the uterus during implantation of a fertilized egg and early luteal phase;
• violation of the maturation and growth of the endometrium, which is one of the most important targets of the antiestrogenic effect;
• underdevelopment of the stroma and glands of the endometrium and a decrease in the thickness of the latter;
• an increase in the viscosity of cervical mucus and a decrease in its amount.

Especially these negative effects are manifested when using high dosages of the drug or its long-term use. Insufficient maturity and thickness of the uterine mucosa by the time ovulation develops during its induction with Clostilbegyt may be the cause of a low percentage of pregnancies and a high number of pregnancies.

In this regard, if pregnancy did not occur in the first four months after ovulation stimulation, further use of Clostilbegit is pointless. This procedure is stopped and the treatment tactics are changed.

Letrozole (Femara)

Letrozole was previously recommended for the treatment of postmenopausal women with breast cancer. In recent years, Letrozole for ovulation stimulation has become, along with Clostilbegit, a first-line drug and is an alternative to the latter. It is prescribed if Clostilbegit is ineffective or if there are contraindications to its use.

The drug is available in tablets of 2.5 mg. In order to induce the ovulatory process, a Letrozole therapy cycle is prescribed from the 3rd day of the menstrual cycle. The duration of admission is 5 days. Dosage regimens are different - most authors recommend dosages of 2.5 mg per day, others - 5 mg.

Letrozole is characterized by a moderate antiestrogenic effect, due to which, after taking it, an increase in the production of follicle-stimulating hormone by the pituitary gland and stimulation of the ovulatory process occur. However, compared to Clostilbegyt, its antiestrogenic effect is less profound and shorter in duration.

The drug also improves the thickness and other indicators of the state of the uterine mucosa, increases the sensitivity of the ovaries to follicle-stimulating hormone. This makes it possible to reduce the required dose of follicle-stimulating hormone administration by 3 times in induction schemes using the latter. In addition, during its administration, side effects are observed very rarely and are not pronounced.

Stimulation of ovulation by gonadotropins

In cases of resistance to clomiphene citrate or in the absence of conditions for its use, preparations of the pituitary follicle-stimulating hormone Gonal-F or Puregon are prescribed, which are available for subcutaneous or intramuscular administration. They belong to the means of controlled induction of the second line.

There are various schemes for the use of these drugs. Stimulation of ovulation with Gonal or Purigon is carried out from the first day of menstruation or the expected day of menstruation, or on the 5th - 6th day after the abolition of the oral contraceptive. Induction is carried out by seven-day cycles in the amount of not more than 6 cycles. The results of the drug administration in terms of the adequacy of the maturation of the follicles are monitored by ultrasound.

1. Step up, or the mode of gradual daily increase (by 40-100%). For the starting dose, 37.5-50 ME are taken. With adequate growth of follicles after a week, the initial dose of the drug in subsequent cycles remains the same. In the absence of their adequate response after seven days, the dosage of the drug in the next cycle is increased by 50%. Such a regimen for the administration of Gonal or Purigon in polycystic ovary syndrome is the most preferable, since it provides a gradual individual selection of the minimum required dose of the drug with a minimal risk of complications.
2. Step down, or step down mode. The program provides for high starting doses (100-150 ME) with subsequent dose reduction. This protocol is recommended for low AMH indicative of low ovarian reserve (usually in women over 35 years of age) and ovarian volume less than 8 cm3, secondary or amenorrhea, and a history of ovarian surgery. However, the use of such a stimulation regimen is limited, since it requires a long clinical experience of a specialist.

HCG to stimulate ovulation

The drug hCG has the effects of luteinizing hormone secreted by the cells of the anterior pituitary gland. It is used after ovulation induction as a trigger for the destruction of the follicle and the release of a mature egg. HCG also contributes to the transformation of the follicle into the corpus luteum, increasing the functional activity of the latter in the luteal phase of the menstrual cycle, and is involved in creating conditions for the implantation of a fertilized egg and in the development of the placenta.

Pregnil, the active ingredient of which is hCG, is available as a lyophilized powder in various doses, complete with a solvent. It is administered once intramuscularly at a dose of 5,000-10,000 IU. The conditions for its introduction, regardless of the induction scheme used, are the achievement of:

1. The leading follicle of the required diameter (not less than 18 mm).
2. The thickness of the endometrium is 8 mm or more.

Ovulation of the egg can occur from follicles with a diameter of 14 mm or more. In order to support the luteal phase, Pregnyl can be administered as a single dose of 1,500 IU every 3 days for 10 days.

The period of onset of ovulation is 36-48 hours after the administration of the drug. At this time, sexual intercourse or artificial insemination is recommended.

Dydrogesterone (Duphaston)

Synthetic dydrogesterone is available in 10 mg tablets under the trade name Duphaston. It is characterized by a selective progestogenic effect on the endometrium, which contributes to the onset of the secretory phase in the latter. In high doses, dufaston can cause suppression of the ovulatory process, but this does not happen when using normal dosages.

Duphaston, when stimulating ovulation, is used at 10-20 mg twice a day in the second phase of the menstrual cycle for at least 18 days, followed by ultrasound diagnosis of pregnancy after 3 weeks. The drug can be used in conjunction with Pregnil or alone to support the luteal phase of the ovulatory process.

Negative effects of ovulation stimulation

The main frequent negative consequences of controlled induction are ovarian enlargement, bloating, mood instability, unpleasant subjective sensations in the form of headaches, paroxysmal hot flashes.

In addition, possible (no more than 10%), intrauterine fetal death, especially with multiple pregnancies, spontaneous miscarriage, ovarian hyperstimulation syndrome.

The latter is a diverse set of symptoms that occurs in response to the sequential administration of follicle-stimulating hormone and hCG preparations. It usually develops by the second - fourth day of induction (early hyperstimulation syndrome), however, there have been cases of late syndrome (at 5 - 12 weeks of pregnancy), which is much more severe.

Depending on the severity of the course, 4 degrees of this complication are distinguished, which can be manifested by discomfort, heaviness and pain in the abdomen, repeated vomiting, diarrhea, swelling of the extremities, face and anterior abdominal wall, ascites, hydrothorax, lowering blood pressure, etc. severe cases require treatment in an intensive care unit.

Hyperstimulation syndrome is the most dangerous complication, which, fortunately, develops very rarely during natural conception and artificial insemination (less than 3-5%), unlike IVF.

The process of their maturation and release is regulated by hormones, but with some disorders in the body, a full-fledged egg is not formed, or it matures irregularly.

This pathology is called, and occurs in most infertile couples in cases where the reason for the lack of conception lies in the woman.

Ovarian stimulation involves the targeted effect on the ovaries of drugs that activate the production of hormones that are necessary for normal ovulation.

Important! Before using the follicle stimulation method, both partners must undergo a complete diagnosis of reproductive function, since cases of male infertility are quite common in medicine.

Reasons for appointment

Ovarian stimulation is a serious medical procedure that is prescribed by a doctor and carried out under strict medical supervision.

Indications for its implementation include:

• hormonal disorders that cannot be eliminated in another way;
• polycystic ovary syndrome;
• obesity or underweight in a woman;
• preparation for IVF (artificial insemination) protocol;
• infertility of unknown etiology.

The diagnosis of "infertility" is made to a married couple if, after a year of regular unprotected sexual intercourse, conception does not occur. For partners over 35 years old, the period allotted for natural insemination is reduced to 6 months.

IVF

With artificial or in vitro fertilization, stimulation is one of the most important steps in the procedure. Its goal is to obtain the maximum number (from 8 to 15 follicles) that can produce high-quality eggs and increase the success of obtaining embryos suitable for implantation.

For reference! The number of follicles that are needed for a successful IVF procedure depends on their size, the woman's age, previous stimulations and the clinic where the treatment is performed. On average, doctors try to get at least 5 mature follicles.

What happens?

Stimulation can be carried out by various means - medications (tablets, injections), folk remedies or vitamins, and each of the methods has its own characteristics, advantages and disadvantages.

Medical

For medication, hormonal preparations or direct-acting drugs are used, which activate the production of hormones in the corresponding parts of the brain.

There are several therapeutic schemes that involve the use of drugs such as Clostilbegit, Chorionic gonadotropin, Pregnil, Dufaston, Utrozhestan, etc.

The choice of a specific drug is carried out by the attending physician, taking into account the age, general condition of the body and other characteristics of the woman's body, as well as the method of fertilization.

Medications that are used to stimulate the ovaries have a number of serious contraindications:

• hereditary diseases, chromosomal or gene pathologies;
• ovarian hyperstimulation syndrome;
• inflammatory and infectious processes in the ovaries, uterus or tubes;
• sexually transmitted diseases;
• severe dysfunction of the kidneys, liver, cardiovascular pathologies.

Attention! It is strongly not recommended to use medications for ovarian stimulation on your own, as this can lead to unpleasant consequences for women's health.

Folk remedies

Stimulation with folk remedies is less effective than medication, and takes more time to achieve a positive result. Most often, in female infertility, medicinal herbs are used, but stimulation by other means is possible. Be sure to consult with your doctor, because. it can cause serious harm to your health.

upland uterus

Red brush and sage belong to the so-called phytoestrogens - plants containing analogues of female sex hormones. Decoctions are prepared from them and taken according to a certain scheme - sage in the first half of the cycle, boron uterus in the second.

Rose petals

The petals contain a large amount of vitamin E, which is necessary for the conception of both partners. Women are advised to take funds with the addition of white and pink rose petals, men - from red and dark pink flowers.

psyllium seeds

The seeds also contain phytohormones - to stimulate the ovaries, you need to prepare an infusion and take it starting from any day of the menstrual cycle.

It is necessary to take folk remedies for the treatment of infertility for a long time - the course is from one to three months.

vitamin therapy

Vitamins are directly involved in the synthesis of hormones, necessary for the successful maturation of the egg, its fertilization and development of the embryo.

It is necessary to take vitamins A, E, B6, B9, D and potassium iodide. They are sold in pharmacies both separately and as part of special complexes for women planning to conceive. Along with the intake of such funds, it is necessary to eat right and lead a healthy lifestyle.

Important! Before taking vitamins, you should consult a doctor, as such drugs have a number of contraindications for use.

At home

Before proceeding, a woman needs to undergo a full examination by a gynecologist, pass tests for infectious diseases and swabs from the genital tract, undergo an ultrasound examination of the pelvic organs, mammary glands and thyroid gland. If the diagnosis "" is confirmed, the doctor chooses the method and scheme of the procedure.

How is it happening?

The woman must take the selected drugs by mouth or by injection. As a rule, the procedure begins on a certain day of the cycle, and it is necessary to strictly follow the schedule for taking and dosage of medicines.

It is necessary to take pills or give injections at the same time, without gaps. At the same time, a woman should strictly follow the doctor's recommendations, give up bad habits and reduce the amount of stress.

Growth by day

To evaluate the effectiveness, a woman undergoes a procedure for measuring the size of the follicles using ultrasound (folliculometry) on certain days of the menstrual cycle.

On average, the size of the follicles should be as follows:

• 5-7 day of the cycle - the size of the follicle is 2-6 mm, and in the ovaries they are determined about 10-12, sometimes more;
• Day 8-10 - dominant appears among the tertiary follicles, its size is about 12-15 mm;
• 11-14 days - the dominant follicle increases by about 2-3 mm per day until it reaches a size of 18-25 mm.

After reaching the maximum size, it bursts, and a mature egg comes out of it - this period (24-48 hours) is the most favorable for conception.

For reference! During the IVF procedure, approximately on the 12-14th day of the cycle, mature eggs are removed by puncture, after which they are fertilized with partner or donor sperm.

Can 2-3 follicles grow?

Normally, in women of childbearing age, several follicles grow, but only one (rarely two) of them contain a mature egg capable of fertilization.

With the stimulation of the ovaries, the maturation of several follicles is possible, which increases the chances of a successful conception.

ultrasound monitoring

During the ultrasound procedure, monitoring is mandatory, as it allows you to control the effectiveness of treatment and, if necessary, make adjustments to the therapeutic regimen. As a rule, a woman must undergo 3 ultrasound examination procedures:

• at the first ultrasound, tertiary follicles are detected;
• during the second procedure, the growth of tertiary follicles is assessed - one of them should become dominant and grow in accordance with the schedule;
• the third study allows you to determine the size of the dominant follicle and the exact time of ovulation.

In some cases, the period of formation and growth of follicles increases, and a woman needs more ultrasound procedures.

2-3 days after the expected ovulation, a control study is carried out - if the dominant follicle is absent, and instead a corpus luteum and fluid behind the uterus are detected, then ovulation was successful.

Consequences and complications

If stimulation is carried out strictly according to indications under medical supervision, the risk of complications is reduced to a minimum.

If the procedure is carried out incorrectly, ovarian hyperstimulation syndrome is possible - a condition when they produce an excessive amount of hormones.

Hyperstimulation is a dangerous condition that requires immediate consultation with a doctor, and in severe cases, treatment in a hospital.

In addition, in order to prevent a violation of the natural function of the ovaries, the stimulation procedure is not recommended for more than 6 cycles in a row.