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.
- 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.
- 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:
- The leading follicle of the required diameter (not less than 18 mm).
- 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.
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:
- 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.
- 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.
- Approximately 3 days before the planned egg retrieval, an hCG injection is carried out.
- From 14 to 21 days, follicle puncture begins. On this day, a man donates sperm. The puncture is affected by the effectiveness of stimulation.
- Fertilization of the egg, thus, occurs 4-5 days after the procedure.
- 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.
- 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.
- 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.
- 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!
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.
The method of in vitro fertilization has long passed from the world of fantasy to modern reality. After all, a huge number of men and women were able to fulfill the dream of becoming parents with his help.
All stages of such a pregnancy are essentially the same as with natural fertilization. However, there is one significant difference between them: IVF creates optimal conditions for successful conception. One of these artificially created conditions is stimulation before IVF. Thanks to stimulation, reproductive specialists have the opportunity to obtain the maximum possible number of mature viable eggs, which increases the chances of pregnancy at times.
Why do ovulation stimulation with IVF
Before the IVF procedure, the doctor must find out what caused the infertility in a woman by prescribing a number of laboratory tests and hardware studies. The most common "female" causes of non-pregnancy include hormonal imbalances that affect the state of the endometrium and the functioning of the ovaries.
To eliminate all factors preventing conception, IVF stimulation is prescribed. This is what hormone therapy is called. Its task is to completely suppress the production of natural hormones: they are replaced with artificial ones. This stage is very important, because thanks to it, the ovaries work not only in the correct, but also in an enhanced mode.
For each woman, a specific treatment system is selected, which is called a protocol. Depending on the protocol, the start of stimulation, the intake of drugs and their dosage are recorded.
Most often, the beginning of an artificial "attack" by hormones is prescribed for 3-5 days of the menstrual cycle. Under the influence of hormonal agents, the ovaries begin to work in an enhanced mode in order to reproduce several dominant follicles at once by the due date of ovulation (in the natural mode, only one such follicle, a maximum of two, matures). The whole process of follicular maturation is clearly monitored using ultrasound diagnostics in order to fix the "day X" in time.
When the dominants mature to the desired size, the follicles are punctured: the reproductologist carefully removes them with an aspiration needle. The more of them there are, the higher the chances of a successful conception.
They are fertilized in a test tube with spermatozoa and left to "ripen" in a nutrient medium in a laboratory. After 3 or 5 days (depending on the indications), reproductive specialists select several embryos, which, according to geneticists, are the strongest and most viable. "Lucky" are transferred to the woman's uterus.
Superovulation Induction Protocols
In the arsenal of reproductologists, there are several types of protocols that are used to stimulate the ovaries. The protocol is prescribed by the attending physician based on the identified pathological abnormalities in the woman's reproductive health, her age, sensitivity to drugs, a tendency to allergies and other individual characteristics.
We have already mentioned that all protocols that result in superovulation are based on the complete or partial blocking of the natural hormonal background. First of all, we are talking about the temporary "destruction" of the natural luteinizing (LH) and follicle-stimulating (FSH) hormone. Their replacement is carried out at the expense of synthesized analogue hormones, the dosage of which is selected individually.
In order to monitor the effectiveness of the drugs used, ultrasound examinations are regularly performed. According to established standards, during ovarian stimulation, the endometrium should grow by 1 mm, and the follicle by 2 mm daily. If ultrasound diagnostics fixes the indicators significantly lower, the methods of ovarian stimulation can be reviewed on an individual basis, starting from changing the dosage of the drug and ending with its change.
Each protocol pursues well-defined goals, regulated by the amount of hormonal agents consumed. Thus, IVF with minimal stimulation aims to collect the maximum number of oocytes in order to subject them to cryopreservation. The fact is that such a treatment regimen does an excellent job with the increased growth of follicles, but inhibits the growth of the endometrium. Therefore, direct replanting of embryos is carried out in other cycles favorable for these purposes.
Read details about different.
How many days does IVF stimulation last?
The time interval is determined by the doctor, based on the state of health of the woman. Therefore, stimulation of ovulation during IVF lasts differently for each patient.
So, a short protocol, lasting one month, provides for ovarian stimulation for 10 days. And for women who have endometriosis, cystic changes on the ovaries, fibroids, hormonal treatment is indicated for 30-40 days, which involves the use of a long protocol. In some cases, super-long ovarian stimulation is indicated, the duration of which can reach up to six months.
The duration of the protocol and the intensity of taking hormonal drugs directly depends on the state of health, age and reproductive characteristics of the woman.
During stimulation, abundant clear discharge may appear. There is no need to be afraid of this: this usually indicates a good growth of the endometrium. You should be wary if there is itching, pain, a sharp unpleasant odor, if the color of the discharge is greenish. All these symptoms may indicate inflammation, which is now completely out of place for you.
Preparations for stimulation
Stimulation of superovulation can only be carried out with the help of synthetic hormonal agents, the appointments, combinations and dosages of which are strictly individual.
The selection of drugs is carried out in accordance with the ongoing stage.
- Stimulation of the ovaries. The main component of the drugs is follicle-stimulating hormone.
- Fertilization of the egg. The drugs stimulate the follicle sheath to rupture, regulating the release of the egg at the right time. The main "actor" of such funds is chorionic gonadotropin.
- Attachment of the embryo to the uterine cavity. Here, the drugs help to "fix the results" in the uterine cavity. Progesterone, being the basis of all these drugs, increases several times the chances of successful implantation of the embryo and its further successful development.
Consider the most important medications that women face during the ovulation stimulation stage.
Orgalutran
Rare stimulation of superovulation does without this drug. It allows you to slow down the amount, and then completely stop the production of LH and FSH. If earlier stimulation with these hormones was not carried out, the suppression of the functioning of the pituitary gland begins immediately after the drug enters the bloodstream.
The average duration of Orgalutran stimulation is 5 days.
Puregon
It is also a drug that belongs to the gonadotropic drugs, as it regulates the production of LH and FSH. With the help of the tool, several follicles ripen at once, and the synthesis of sex substances is activated.
Used to stimulate natural ovulation and in IVF protocols.
Gonal
Stimulation by "Gonal" reproductive specialists call "heavy artillery". The drug, produced by an Italian company, is used to treat male and female infertility. It shows excellent results where other drugs have failed.
The use of the drug requires careful monitoring of the growth of follicles on ultrasound: as soon as the follicle reaches 17 mm, it is canceled.
Clostilbegit
Clostilbegit is used in various stimulation protocols. However, most often its appointment is justified in the “light” protocol, when, after stimulation, the maximum number of eggs is “collected” for cryo-freezing.
Replanting is carried out in the next cycle, because, despite the excellent performance in maturation of the follicles, the drug reduces the growth of the endometrium, which will not allow the successful attachment of the embryo to the uterine cavity.
Cetrotide
A drug that, by blocking the natural hormones of ovulation, cannot replace them with artificial counterparts in sufficient quantities. As a result, ovulation is "delayed".
To delay the onset of ovulation during IVF will be needed in two cases:
- If you need superovulation;
- If necessary, regulate the menstrual cycle so as to allow the follicles to fully mature.
Agonist drugs
Agonists (that is, analogues) of gonadotropin-releasing hormone are Diphereline, Decapeptil, Lucrin-depot and some others. These drugs work directly on the "elimination" of the functioning of the pituitary gland, thereby creating optimal conditions for the growth of a large number of follicles.
The drug is prescribed for 6-7 days after the onset of ovulation. As a rule, 4-5 injections are enough for a successful stage.
Menopur
With IVF, ovarian stimulation with Menopur shows good results.
The drug, the main component of which is human menopausal gonadotropin, is prescribed to stimulate follicular growth, improve the uterine mucosa, and also actively produce estrogens. A drug derived from the purified urine of menopausal women is often used in combination with products containing hCG.
HCG preparations
HCG injections are intended for the final preparation of "ripening" follicles for puncture. The injection is administered two days before the intended collection of ready-made eggs. HCG preparations are administered once; hormonal control is not required after the injection.
HCG medicines may have different names depending on the manufacturer. Most often you can find the name "Pregnil".
How to inject yourself
Many patients give themselves injections themselves. Doctors do not mind if a woman has experience with intramuscular injections or has acquired a special device. It allows you to use not a syringe with a needle, but an injector pen.
The doctor, making appointments, will indicate which drugs are administered intramuscularly and which subcutaneously. Also, this nuance is described in the instructions. Regardless of the method of administration of the drug, you should know a few important rules for their use:
- The injections are given at the same time;
- The drug is administered extremely slowly;
- If you miss an injection, contact your doctor immediately to find out what to do next;
- Do not increase or decrease the dosage yourself!
Do not forget that before the injection you need to thoroughly wash your hands and disinfect the injection site.
How to behave during stimulation
IVF stimulation is an important period during which a woman experiences a whole range of emotions: from joyful hope to deep despair from the fear that nothing will work out. At this crucial time, the support of loved ones, a stable psychological state, many hours of calm walks in the fresh air and a healthy diet are very important. Diet for weight loss and excessive exercise should be a thing of the past, and an optimistic attitude should become the present and future.
However, the diet is still needed, but not "weight loss", but a special one. It is important to consume a lot of protein (lean meat, cottage cheese, eggs) and foods with plant fiber, that is, vegetables and fruits. At the same time, use less animal fats and more vegetable fats. Protein food is needed to prevent ovarian hyperstimulation. And fiber and vegetable fats will contribute to comfortable digestion, which is very important at this stage. But if you have gastritis or other gastrointestinal problems, check your diet with a gastroenterologist. Most likely, he will advise replacing raw vegetables with boiled ones, and raw fruits with baked ones.
A few more important principles:
- Avoid infectious and colds in order to prevent excessive stress on the immune system: it has a more important mission ahead of it.
- Give up coffee and caffeinated drinks: they can interfere with the hormonal background and interfere with conception.
- Avoid hot baths, do not go to the sauna.
- Give up cigarettes, passive smoking and alcohol in any doses.
- Avoid taking any medications other than those prescribed by your fertility doctor. All other drugs (for example, if you have chronic diseases that require medication) - only as a last resort and in agreement with the reproductologist.
Possible Complications
Stimulation of ovulation before IVF involves the use of only hormonal drugs. A prolonged "attack" of synthetic hormones can lead not only to a deterioration in the general condition of the patient, but also to unpleasant complications.
ovarian hyperstimulation
Multiple pregnancy
Ectopic pregnancy
Occurrence is a rare complication. However, if immediately after embryo transfer you feel severe pain, weakness and dizziness, immediately consult your doctor: the attachment may have occurred outside the uterine cavity.
In general, IVF, if carried out by an experienced reproductive specialist, is a difficult, but very effective treatment with good chances of pregnancy and the birth of a healthy child.
