How is the process of ovulation stimulation going?

Why and how is ovulation stimulation performed?

A large number of pathologies - chromosomal, endocrinological, gynecological and others - are accompanied by a lack of ovulation. As a result, a woman who may otherwise be completely healthy is unable to conceive. Stimulation of ovulation helps to solve the problem, which consists in the introduction of a certain hormonal drug, the dose and method of administration of which is carried out by the doctor.

The essence of the method

Ovulation stimulation is a method used to treat female infertility caused by ovulation disorders. It is based on the effect on the ovaries of a woman by analogues of those hormones that are normally produced in the female body. Their antagonists may also be used. The effectiveness of the stimulation method is 60-75%.

The purpose of the use of hormones is to artificially stimulate the maturation of eggs, if it is found that they are formed in the ovaries, their structure is not disturbed, only they do not fully mature. If the structure of the developing egg is disturbed, stimulation is not used.

The fact how effective the method will be in a given case will depend on:

• reasons for the lack of ovulation;
• woman's age;
• type of drug;
• the presence of other factors in her or her spouse that support infertility.

Indications for the procedure

Stimulation of ovulation is carried out in such cases:

1. Hormonal dysfunction that cannot be cured in any other way.
2. Inability to become pregnant within a year of regular sexual activity, in the absence of identified pathology in a woman and a man.
3. As preparation for artificial insemination methods - IVF and ICSI.
4. Low or, conversely, a high body mass index of a woman.
5. Polycystic ovaries.

What tests need to be done?

Preparation for stimulation

Before prescribing drugs, both spouses should be carefully examined. They donate blood to determine:

• antibodies to HIV;
• Treponema pallidum antigens (RW);
• markers of hepatitis B and C;
• crops from the genital tract in order to detect: trichomoniasis, candidiasis (thrush), PCR examination of smears for the genome of mycoplasma, gardnerella, ureaplasma.

Separately, a woman passes:

• smears from the cervical canal and vagina for purity and atypical cells;
• Ultrasound of the small pelvis;
• Ultrasound of the mammary glands;
• determination of antibodies to the TORCH-complex of microbes (rubella, toxoplasmosis, cytomegalovirus, chlamydia);
• examination by a therapist, ECG and other tests for the presence of common diseases that may be a contraindication to carrying a pregnancy;
• determination of the patency of the fallopian tubes using one of these methods: laparoscopy, X-ray examination of the uterus and tubes with contrast, ultrasound with contrast;
• blood levels of female sex hormones, prolactin, thyroid hormones, testosterone are determined several times; when their level changes, a correction is carried out;
• folliculometry is performed, which, to start ovulation stimulation, should show one of the following results:

1. no development of follicles in the ovaries;
2. the follicle develops, stopping in growth, not reaching the desired size, there is no ovulation;
3. the dominant follicle develops, stops, not reaching the required size, there is no ovulation;
4. the dominant follicle grows to the desired size, but does not break, that is, ovulation does not occur.

Before stimulating ovulation, a man submits for analysis the sperm obtained after the absence of coitus for 3-5 days.

Assessment of ovarian reserve

After both spouses are examined, and the doctor concludes that nothing should prevent conception, and they do not suffer from such diseases in which there is a chance of having a sick child, the ovarian reserve is determined. This term refers to the estimated response of a woman's ovaries in response to ovulation stimulation: whether the procedure will cause the maturation of several eggs, or not. With the help of an assessment of the ovarian reserve, it is determined:

• does ovulation stimulation itself make sense;
• what should be the intensity of the procedure;
• the choice of the optimal stimulation protocol is made;
• preparations and their doses for this woman are selected.

This test is especially important for women over 35 and those who suffer from unexplained infertility.

How is ovarian reserve tested?

The doctor chooses one of the following methods for determining this indicator:

1. On the 2-3 day of the cycle, the level of such hormones in the blood is determined: follicle-stimulating (FSH), luteinizing (LH), estradiol. An increase in their concentration above normal during this period indicates that the response to stimulation will be poor.
2. After determining FSH on the 3rd day of the cycle, from 5 to 9 days, the woman is prescribed "Klostilbegit" at a dose of 100 mg per day. On day 10, blood is again given to the FSH level: its significant increase indicates that the ovaries are not ready for stimulation.
3. A test with stimulation with drugs that act in the same way as the substance produced in the hypothalamus - gonadotropin-releasing hormone (GnRH). At the same time, the level of estradiol in the blood is determined in a woman, then she receives an injection with a test dose of this drug, after which the same hormonal metabolite is again determined. The fact that a good response to stimulation is predicted is indicated by an increase in the concentration of estradiol.

Methodology

Procedure procedure

The stimulation of ovulation itself consists in taking hormonal drugs, which are selected individually and prescribed according to a special scheme (it is called a protocol). Hospitalization of the patient is usually not carried out. The effectiveness of the procedure is monitored according to ultrasonic folliculometry.

Preparations for stimulation

There are several main groups of hormonal drugs that stimulate ovulation.

Clomiphene (clostilbegit, clomid)

This is a drug whose action is to stimulate the production of gonadotropic hormones. It specifically binds to the receptors of the hypothalamus and pituitary gland, triggering the synthesis of sex hormones in these glands; in large doses inhibits their secretion. Has an antiestrogenic effect; does not stimulate the production of male sex hormones and progestogens. Can be used for dysfunctional uterine bleeding.

It should not be prescribed more than 5-6 times in a lifetime, as it leads to premature exhaustion of the ovaries, that is, early menopause. Clomiphene is also not used for problems with endometrial growth. The drug is contraindicated in inflammatory processes of the reproductive female organs, with renal and hepatic insufficiency, pituitary insufficiency. It can also not be used in the case when ovarian failure is accompanied by increased secretion of prolactin.

Clomiphene citrate is prescribed, usually from 5 to 9 days of the cycle. Its dose depends on what structure of the ovaries the doctor saw on the ultrasound:

• with polycystic or multicystic ovaries, the daily dose is 50 mg;
• with a normal structure, 50-100 mg per day can be used;
• if the ultrasound describes the ovaries as "exhausted", estrogen stimulation is first needed, then Clomiphene 100 mg / day is used.

"Klostilbegit" is not prescribed by itself. Its application is included in the following protocol:

1. the above dose is applied until, according to ultrasound, the follicle reaches a size of 18-25 mm;
2. stop the introduction of "Clomiphene", enter chorionic gonadotropin in the form of an injection, which should cause the release of the egg;
3. throughout the second phase of the cycle, the woman takes progesterone preparations ("Progestogel"; "Utrozhestan");
4. from 5 to 21 days, estrogen preparations are prescribed ("Divigel", "Estrogel", "Proginova").

Menopausal gonadotropin

It is a hormone produced by the pituitary gland. It is obtained from the urine of women during menopause; contains FSH and LH in approximately equal amounts. Its task is to regulate the phases of the cycle in a non-pregnant woman. It stimulates the growth and development of follicles, increases the level of estrogen in the blood. Under its action, the proliferation of the endometrium occurs. To stimulate the release of the egg 1-2 days before the end of the introduction of "Menopur" ("Pergonal", "Humegon"), a preparation of chorionic gonadotropin is used.

The effectiveness of the drug is judged on the basis of ultrasound of the ovaries, as well as the level of estrogen in the blood. The dose is selected individually: they start with 75 mg / day, gradually increasing it until the level of estrogen in the blood increases or the follicle begins to mature. After that, the dose is left unchanged.

The drug "Menopur" is used:

1. in the event that the stimulation with "Klostilbegit" is ineffective;
2. if there is no ovulation due to hypothalamic-pituitary disorders;
3. if ovulation is stimulated in the complex of assisted reproductive technologies.

The drug is contraindicated in:

• anomalies in the development of the reproductive organs;
• unclear bleeding from the uterus;
• tumor diseases of the reproductive system;
• tumors of the pituitary or hypothalamus;
• tumors that produce male sex hormones;
• hypersensitivity to the drug.

Recombinant follicle stimulating hormone

This is a hormone synthesized using genetic engineering technologies, similar in action to natural FSH. Commercial names - "Gonal-F", "Puregon".

The drug is effective for those women who have a suppressed secretion of their own gonadotropic hormones, has a more powerful effect compared to urinary gonadotropins. It applies:

• with polycystic ovary syndrome, when Clomiphene therapy was not effective;
• if FSH and LH are significantly reduced in the blood;
• as hyperstimulation in assisted reproductive technologies.

Contraindications to Gonal are the same as to Menopur.

Chorionic gonadotropin

This is an analogue of the "pregnancy hormone" produced only during this period. It is necessary for the maturation of eggs, ensuring adequate ovulation. It is used in the scheme with Menopur, Gonal or Clomiphene.

If Horagon (Pregnyl, Profazi) is used in conjunction with Menopur or Clomiphene, a side effect of this drug may develop - ovarian hyperstimulation syndrome. They may even break.

Gonadotropin-releasing factor agonists

The action of these drugs is aimed at suppressing a sharp increase in the level of luteinizing hormone, which normally causes ovulation. As a result, the follicles mature better. The drugs "Diferelin", "Leuprorelin", "Buserelin" are used in the IVF program, together with one of the above drugs.

These drugs are used both in the form of ultrashort courses and for a long time. At the beginning of treatment, the level of luteinizing hormone rises for a short time, there is a lack of estrogens.

Taking Gn-RH agonists causes a large number of side effects:

• dryness in the vagina;
• sweating;
• headache;
• mood swings, especially depression;
• tides.

Gonadotropin-releasing hormone antagonists

They immediately suppress the production of sex hormones (especially LH) by the pituitary and hypothalamus without any initial increase. Stimulation of ovulation in the case of the use of these hormones is less prolonged: either a single or three times their administration is used.

These drugs, in combination with Gonal-F, allow follicles to grow faster than in other situations; while the dose of "Gonal" can be reduced. In addition, fewer follicles are stimulated and the resulting embryos are of higher quality. The drugs are used in IVF programs.

How is stimulation done?

Stimulation of ovulation is carried out according to one of the developed protocols, that is, according to a regulated method that describes the dose, method and duration of administration of each of the drugs included in the standard. The stimulation protocol is selected taking into account:

1. results of an assessment of the ovarian reserve;
2. woman's weight
3. the results of previous procedures that stimulate ovulation.

Contraindications for ovulation stimulation

General contraindications for stimulation

Ovulation stimulation is not carried out with:

• pathological processes that will prevent conception and / or the normal course of pregnancy: tumor diseases of the female reproductive organs, extensive adhesions in the fallopian tubes;
• lack of effect during the stimulation procedure, carried out before 6 or more times.

A relative contraindication is age over 35 years. This is due to the fact that in this case, the chances of having a sick child are significantly increased.

Possible complications of stimulation

Almost all drugs to stimulate ovulation can lead to the development of hyperstimulated ovary syndrome, which begins to manifest itself after the introduction of chorionic gonadotropin drugs. This manifests itself:

• the appearance of large ovarian cysts;
• accumulation of fluid in the abdominal, pleural cavities;
• lowering blood pressure;
• decrease in the level of daily urine;
• blockage of blood vessels.

A side effect of ovulation stimulation can also be allergic reactions and multiple pregnancies.

Thus, one of the basic drugs (“Menopur”, “Gonal” or “Klostilbegit”) is used to stimulate ovulation, the choice is made by the doctor based on the woman’s hormonal background, age, and ovarian reserve. Additionally, gonadotropin-releasing agonists or antagonists are prescribed (the latter are considered more effective). Additionally, drugs containing progesterone or estrogen may be used. A few days after the use of these drugs, chorionic gonadotropin is administered once, after which either IVF is performed, or the woman is recommended to start sexual intercourse.

Ovulation stimulation is considered the most common and popular way to achieve a long-awaited pregnancy. But it has its pros and cons.

We will talk about how artificial stimulation of natural processes for a woman takes place, what drugs are used and what results can be achieved in this material.

What it is?

Every or almost every month in the body of a healthy woman capable of conception, ovulation occurs. After menstruation during the first half of the cycle, which lasts approximately 14 days, follicles mature in the ovaries. One of them, the dominant one, bursts in the middle of the cycle and releases an egg ready for fertilization.

Ovulation and subsequent periods are usually separated by 14 days. If the cycle lasts 28 days, then ovulation should be expected on the 14th day of the cycle if the individual characteristics are such that the cycle has a duration of 30 days, then ovulation occurs on the 16th day, with a cycle of 32 days, ovulation usually occurs on the 18th day.

Ovulation Calculator

Cycle duration

duration of menstruation

• Menstruation
• Ovulation
• High chance of conception

Enter the first day of your last menstrual period

Ovulation occurs 14 days before the start of the menstrual cycle (with a 28-day cycle - on the 14th day). Deviation from the mean value is frequent, so the calculation is approximate.

Also, along with the calendar method, you can measure basal temperature, examine cervical mucus, use special tests or mini-microscopes, take tests for FSH, LH, estrogen and progesterone.

You can definitely set the day of ovulation through folliculometry (ultrasound).

Sources:

1. Losos, Jonathan B.; Raven, Peter H.; Johnson, George B.; Singer, Susan R. Biology. New York: McGraw-Hill. pp. 1207-1209.
2. Campbell N. A., Reece J. B., Urry L. A. e. a. Biology. 9th ed. - Benjamin Cummings, 2011. - p. 1263
3. Tkachenko B. I., Brin V. B., Zakharov Yu. M., Nedospasov V. O., Pyatin V. F. Human Physiology. Compendium / Ed. B. I. TKACHENKO. - M.: GEOTAR-Media, 2009. - 496 p.
4. https://en.wikipedia.org/wiki/Ovulation

But this is ideal, but in practice small deviations from the rules are acceptable.

The release of the egg occurs within one hour, then for another day it retains the ability to fertilize and waits for the sperm in the fallopian tube. Conception is only possible during ovulation., because the process of egg release is regulated by the pituitary gland, which begins to produce luteinizing and follicle-stimulating hormones.

Under the influence of FGS (a hormone that stimulates the growth of follicles), in the first half of the cycle, an increase in the follicle occurs, under the influence of luteinizing hormone (LH), the egg itself inside it can mature in a fairly short time.

After the egg is released, it slowly moves through the tube towards the uterine cavity. If fertilization occurs, then the embryo descends into the uterus, and if conception did not happen, then the egg also descends into the uterus and dies there within a day.

As a result of hormonal failure, ovarian dysfunction, and for a number of other reasons, the cycle provided by nature can be disrupted, and therefore a woman can experience anovulatory cycles, that is, cycles without ovulation.

These can be cycles when the egg does not mature, or matures, but does not leave the follicle. In this case, it is impossible for a woman to get pregnant naturally.

Doctors come to the rescue, who can stimulate the ovaries to plan pregnancy. Most often this is done with hormone therapy.

Stimulation of ovulation gives a real chance for conception to couples who have not been able to get pregnant on their own for a long time. The procedure belongs to the category of assisted reproductive technologies.

Indications - for whom is it performed?

This method annually helps tens of thousands of women to find the joy of motherhood. First of all, stimulation is indicated for women with polycystic ovaries, with various manifestations of their dysfunction, including age-related ones. Medical artificial stimulation of ovulation is usually not for women over 40.

With complaints about the inability to get pregnant, a woman turns to a gynecologist. The doctor studies not only the state of her reproductive organs, but also the features of the menstrual cycle. Such diagnostics include mandatory tracking of follicle maturation using ultrasound diagnostics.

If this examination shows that ovulation is not occurring, preparation for stimulation begins.

The main indication for drug stimulation of the ovaries is the absence of pregnancy during the year, provided that the spouses are not protected and live a regular sexual life. If the spouses (especially a woman) are already 35 years old or more, then the waiting period for conception in a natural way is reduced to six months.

The procedure is contraindicated in women suffering from obstruction of the fallopian tubes.: Otherwise, an ectopic pregnancy may occur. Also stimulation is not carried out in patients with inflammatory processes in the ovaries and other pelvic organs.

Another indication for stimulation is the absence of menstruation, which arose against the background of hypothalamic-pituitary insufficiency.

The reason for the procedure may be preparation for IVF or intrauterine artificial insemination - insemination. Doctors are usually quite successful in stimulating the multifollicular ovaries, and there are stimulation schemes for endometriosis.

In case of hormonal failures, when ovulation is often “late”, stimulation of late ovulation is carried out.

Also the procedure is indicated for women with significant metabolic disorders, which is manifested by obesity or, conversely, underweight, because under these conditions it is often impossible for a couple to get pregnant on their own.

Methods of artificial stimulation

There are many ways to support ovarian function and help ovulation occur.

In addition to drugs, pills and injections as part of hormone therapy, which is used to restore the ovaries and provoke the release of an egg from a mature follicle, folk remedies that women practice at home are widespread. These are herbs, mud therapy, vitamin therapy and some physiotherapy procedures, such as acupuncture.

Some even practice yoga for conception. Some asanas (postures), according to women, are a good addition to complex treatment and contribute to the improvement of the whole organism as a whole and the reproductive system in particular.

Despite the huge number of recommendations and ways to achieve what you want, the main method with proven effectiveness, in which the effect is to a lesser extent explained by the usual fortunate combination of circumstances, is medical hormonal stimulation.

How is drug stimulation, preparation

After a woman visits a doctor, she and her partner are recommended to undergo a detailed examination to establish the true cause of family infertility. A woman is assigned the whole range of laboratory tests from general and detailed blood and urine tests to blood tests for infections, including sexually transmitted ones.

It is necessary to do a blood test for hormones(lutenizing, follicle-stimulating, progesterone, prolactin and a number of others, if the doctor considers it necessary).

woman mandatory ultrasound of the pelvic organs and mammary glands. Sometimes a laparoscopic diagnosis may be required to make sure that the fallopian tubes are patent.

Sexual partner of a woman takes blood tests for infectious diseases, genital infections, and also undergoes a spermogram to determine the quality of his germ cells, since with male infertility, without exception, all ovulation stimulation schemes will not give any result.

If a pathology inside the uterus is suspected, hysteroscopy is performed.

As soon as the first stage, diagnostic, is left behind, the second stage begins - the treatment of existing inflammatory diseases and hormonal imbalances. Sometimes at this stage, a woman manages to get pregnant., since the pathologies that caused her failures in the ovulatory cycle, in most cases, can be treated.

Women who are overweight or underweight (weight less than 45 kilograms) are prescribed a course of body weight correction. According to the observations of specialists, it is sometimes enough for a patient to reduce her weight by only 10% in order for ovulation to begin to occur on its own.

The third stage is stimulation itself. Ovulation stimulation protocol schemes can be different. The doctor determines the specific drug, its dosage, duration and frequency of administration on an individual basis, taking into account the age, weight and gynecological history of the patient.

Sometimes the turn does not reach the hormones. Pregnancy occurs before the third stage in the event that a woman manages to completely reconsider her attitude to unsuccessful attempts to get pregnant. Fear, anxiety, worries, grief, disappointment at the psycho-physical level trigger the blocking of estrogen production, so ovulation does not occur.

If a woman learns to properly relate to failures, to perceive them as a temporary phenomenon and extremely harmful to her health, the ovulatory cycle is often restored without medication at all.

At the initial stage, doctors try to prepare the endometrium of the uterus. With a thin endometrium, conception, even if it occurs, may not lead to pregnancy, because it will be difficult for the embryo to gain a foothold in the uterine cavity. For preparation, a course of treatment with preparations of female sex hormones is carried out.- Proginova, the external drug Divigel and other drugs are used that contain the hormones estrogen and progesterone.

As a rule, from the 5th day of the cycle, special preparations are prescribed, at the same time, doctors monitor the maturation of the follicle by ultrasound.

Activities should begin immediately after the end of menstruation.

It is possible that a woman will have to visit the ultrasound diagnostic room from the 10th day of the menstrual cycle every day. As soon as one of the follicles reaches a size of 17-18 mm, stimulation can be carried out and after 24-36 hours, expect the onset of the cherished moment - ovulation itself.

Still in preparation a woman must donate blood for a hormonal analysis in order to determine the level of AMH- Anti-Müllerian hormone, which is "produced" by the growing structures of the follicles.

If a woman's own AMH level is low, the ovarian response to stimulation will be weak and the effectiveness of the protocol will be significantly reduced. The level of this hormone during examination in dynamics will also allow doctors to see the effectiveness of stimulation and prevent excessive hyperstimulation.

You can stimulate the ovaries up to three times in a row, that is, for three cycles. If conception does not occur, a break is required so that the ovaries can rest from the "hormonal attack" and recover. During this time, the man and woman visit the doctor again, who can make adjustments to the treatment regimen.

A total of 5-6 pacing cycles are considered acceptable.. If they did not bring results, the method is recognized as ineffective for this pair., they are recommended other assisted reproductive techniques, including surrogacy, removal of mature healthy eggs from the ovaries with subsequent in vitro fertilization, fertilization of a donor egg with the husband’s sperm, etc. It all depends on the true causes of infertility and whether a woman develops her own healthy germ cells.

It is not worth insisting on continuing to stimulate ovulation, after 5-6 courses there is a high probability of irreversible exhaustion of the ovaries, their premature aging.

To stimulate ovulation, you do not have to go to the gynecological hospital. A woman can stay at home, in her usual conditions. She must strictly adhere to the prescribed schedule of visits to the doctor for ultrasound control, and also take all prescribed drugs in full accordance with the indicated individual dosage.

Drugs - list

All drugs that are included in the schemes of ovulation stimulation protocols are divided into two large groups:

• follicle growth stimulants;
• ovulation triggers.

The first ones are prescribed from the 5th day of the cycle (immediately after menstruation), and the triggers are introduced one-time - when the ultrasound shows the complete readiness of the follicle to release an egg. They imitate the release of luteinizing hormone, under the influence of which the egg quickly matures and leaves the follicle.

After ovulation has taken place, drugs are prescribed that help the ovaries maintain the functions of the corpus luteumso that pregnancy, if it occurs, can develop normally. Let's look at the drugs of all these groups in more detail.

"Klostilbegit" ("Clomiphene citrate", "Clomid")

This drug is widely known to women planning a pregnancy, as it has proven itself as a means of stimulating the ovulatory process. The drug is a stimulant for the formation and growth of follicles in the ovaries.

In certain doses, it helps the production of follicle-stimulating hormone FSH, luteinizing hormone (LH) and gonadotropins. The tool is available in the form of tablets.

There are no general recommendations on the dosage regimen of the drug, because the dose depends on how the ovaries will respond to taking this medication - it can be reduced or increased at the discretion of the attending physician.

If a woman's menstruation occurs fairly regularly, there are no long-term failures, then treatment with Clomid begins on the 5th day of the cycle (count from the first day of menstruation). According to one of the common schemes, the drug is taken every day for five days, in this case, ovulation is expected presumably from the 11th to the 15th day of the cycle.

If there is no ovulation, then in the next cycle another scheme is introduced, in which the drug must be taken from the 5th day of the cycle for 5 days, but at a doubled dosage.

If both schemes do not show results, treatment is interrupted for three months, after which the course may be repeated..

For each course, a woman should not take more than 750 mg of the drug. After the second course, if it did not bring the long-awaited result, treatment with Clomid is recognized as completely ineffective and other methods of assisted reproductive plan are chosen.

Side effects of the drug can cause discomfort to a woman. These are nausea, vomiting, flatulence, headache, increased drowsiness, lethargy of movements and mental reactions, therefore, for the duration of treatment, a woman is advised to refuse to drive a car and work associated with high risks to life.

Many women, while taking Clomid, notice that they are overcome by a depressive mood, their sleep and appetite are disturbed. There may be pain in the lower abdomen, slight pain in the chest, white liquid discharge from the genitals.

"Klostilbegit", like other drugs that stimulate follicular growth, increase the risk of subsequent onset of multiple pregnancy. Many women note that during the treatment they gain some weight.

Analogues of this remedy are Clomiphene, Serofen, Serpafar.

"Letrozole"

This nonsteroidal drug is also enhances FSH production and promotes ovulation However, experts consider it more effective than Clomiphene, although Clomiphene remains the first choice.

Letrozole has significantly fewer side effects which makes it more pleasant to take. In addition to the regulation of hormones, the drug improves the condition of the endometrium. There are also several schemes by which this remedy can be taken in tablets.

In the first case, 2.5 mg is prescribed from the third day of the cycle for five days; in the second scheme, a woman is recommended to drink the drug from the fifth day of the cycle at a dose of 5 mg.

The best results are shown by the use of this agent as part of complex therapy: on the second to sixth day of the cycle, Letrozole is prescribed at a dosage of 2.5 or 5 mg per day, then from the 7th to the 10th day of the cycle, the woman is injected with FSH in injections, and then they give an injection of hCG at a dosage of 10,000 U, as soon as the dominant follicle reaches the desired size according to ultrasound (from 18 mm).

Analogues of the drug - "Letrosan", "Femara".

"Gonal-F"

This drug also belongs to the group of drugs, stimulate the growth and development of follicles in the ovaries in the first half of the menstrual cycle. It contains a recombinant hormone, which, thanks to the efforts of genetic engineers, was obtained from the ovary cells of female Chinese hamsters.

The drug is administered subcutaneously, it is sold in special syringe pens that are easy to use. "Gonal-F" is prescribed if stimulation with the first drug in the order of appointment - "Klostilbegit" is ineffective.

Similar actions of this drug are typical for many hormonal drugs - these are headaches, dizziness, drowsiness and lethargy, lack of tone, dryness in the vagina, changes in appetite, insomnia. Sometimes women report diarrhea, temporary blurred vision, acne, weight gain.

The agent is injected subcutaneously. The doctor will make the first injection, and the subsequent woman will be able to inject herself yourself at home.

The stimulation course begins in the first days of the cycle and lasts up to 11-14 days. The dose of administration is determined by the doctor, usually starting with 75-10 IU and gradually increasing the dosage.

With each subsequent injection, a woman needs to choose a new injection site, do not inject into one zone.

Analogues of the drug - "Horagon", "Ovitrel".

"Puregon"

This preparation can also be used for the initial preparation of the follicles in the first half of the cycle. It is available in the form of a powder for solution for injection, as a ready-to-use solution and a solution in cartridges. The liquid is administered intramuscularly and subcutaneously. The drug in the "pen" is administered in only one way - subcutaneously.

The drug contains recombinant FSH from the same Chinese hamster, which in many respects outperforms FSH obtained from human urine. It is safer and easier to carry.

Under its influence, several follicles begin to actively grow in the ovaries of women, which can then be used in any of the assisted reproductive methods.

The dose depends on how the patient's ovaries will "respond" to the impact.. Daily monitoring of ultrasound and the determination of estrogen in the blood will help the doctor to have a good idea of ​​​​what exactly is happening in the woman's gonads, and not to miss the moment of ovulation.

The initial dose is 50 IU, then, if there is no ovarian response, the dosage is increased daily and monitored when the response appears. Treatment begins on the second day of the menstrual cycle, it lasts about 7-14 days (it all depends on when it is possible to achieve growth of follicles and an increase in the concentration of estadiol in the blood). The stimulation is completed by an injection of hCG at a dose suitable for ovulation induction (usually 10,000 IU).

Chorionic gonadotropin (hCG)

This drug is obtained from the urine of pregnant women, since this hormone is produced in large quantities in the initial period of bearing a baby - most intensively up to 12 weeks. An injection of this remedy in a dosage of 5000 to 10000 IU is used in order for the very fact of ovulation to occur so that the egg can leave the follicle stimulated in the first stage.

Then the drug can be administered every two days until the date of the expected menstruation, in order to maintain the functions of the corpus luteum, which produces sex hormones, which are necessary to maintain pregnancy.

If pregnancy is confirmed, hCG can also subsequently be used up to 10-11 weeks if there is a threat of miscarriage due to low intrinsic hCG levels.

If a woman has a threat or fact of ovarian hyperstimulation on ultrasound, then they refrain from using hCG. It is also not recommended to use chorionic gonadotropin for women with kidney and liver pathologies.

Among the side effects of the drug are irritability and mood swings, headaches, drowsiness. HCG also increases the chance of conceiving twins or triplets, and this fact cannot be ignored when planning a pregnancy.

The analogue of the drug is "Pregnil".

Dydrogesterone (Dufaston)

This is a popular hormonal drug, the main active ingredient of which is an analogue of progesterone. The tool can be indispensable in the second half of the menstrual cycle, because it helps to maintain pregnancy, promotes proper implantation, regulates many processes, setting the woman's body to a new state for her.

Ovulation "Duphaston" has no effect, but here after it, it becomes very important, because it strengthens the possible positive result of stimulation. The drug does not affect the growing embryo, and therefore its use in the first weeks and months of pregnancy is not prohibited, and sometimes recommended.

The dosage is prescribed individually depending on the result of a blood test for progesterone, as well as the purpose of taking - pills can be prescribed not only to control the level of the hormone, but also to prevent the threat of miscarriage, to prevent miscarriage, if such facts have previously occurred.

From "Duphaston" women do not get fat, do not lose concentration, and therefore can continue to drive a car without restrictions while taking this drug.

Vitamins to stimulate ovulation

Vitamin preparations are included in the standard treatment regimens for female and male infertility. When stimulating ovulation, taking vitamins is indicated 1-2 months before the cycle chosen for stimulation, as well as throughout the entire time that stimulation is in progress, and then until pregnancy is confirmed.

Sometimes in order to establish regular ovulation, it is enough to adjust a woman's lifestyle, her diet and prescribe her vitamins, so vitamin support at the stage of pregnancy planning is of great importance.

Vitamins D, A, B12, B 9, E, C are especially important for the normalization of ovulatory cycles:

• Vitamins D and D 3 involved in the production of sex hormones in women.
• Without vitamin A the development of the follicle is not bypassed, in addition, retinol is involved in the normalization of the composition of cervical mucus.
• Vitamin E participates in cellular processes, helps the maturation of the egg, contributes to its release beyond the follicle.
• Ascorbic acid (vitamin C) improves blood circulation, which contributes to the enrichment of the ovaries with useful substances.
• B vitamins, especially folic acid, regulate the duration of the luteal phase of the cycle, and also increase the viability of the egg.

• From the beginning of menstruation to ovulation - vitamin E, vitamin A and folic acid.
• From the moment of ovulation throughout the second phase of the cycle - vitamin C, vitamins B, vitamin E.

Specific vitamin preparations should be prescribed by a doctor, taking into account a biochemical blood test, which shows which substances are needed, and which ones are enough without synthetic preparations.

An example of a successful vitamin therapy regimen can be as follows:

• Days 1 to 14 of the cycle- cocarboxylase + riboflavin (in injections) daily, as well as lipoic acid and vitamin E in tablets and capsules.

• 15th to 24th day of cycle- riboxin, pyridoxine, folic acid and potassium orate tablets, as well as vitamin E three times a day.

Treatment with folk remedies

Our ancestors knew something about women's health long before such concepts as "stimulation of ovulation" appeared. However, experts tend to believe that probability theory plays an important role in alternative medicine - there is always a chance to conceive, and therefore drinking weed, in principle, will not hurt.

Modern doctors respect folk remedies to improve women's health, but warn against their self-appointment.

Any alternative treatment should be discussed with your doctor so as not to harm.

For folk ways to increase ovulatory ability, there are also certain rules. For example, do not take herbs at the same time as hormone therapy with medications, this can lead to ovarian hyperstimulation.

Herbs and roots for female fertility are not taken during menstruation, and it is not recommended to be treated with them for more than 3 months in a row, as well as hormonal medications.

The principle of treatment in alternative medicine is exactly the same as in traditional medicine. In the first half of the cycle, herbal remedies are taken that help the growth and development of the follicle.. This is sage - decoctions and essential oil, a decoction of rose petals, an infusion of plantain seeds.

In the second half of the menstrual cycle, after ovulation, traditional healers recommend taking a boron uterus- This plant contains plant progesterone. Decoctions and infusions are made from it, according to the instructions for use, which is enclosed in pharmacy packages with this herbal tea.

To achieve ovulation, a woman is advised to stop drinking alcohol, do not abuse nicotine, diversify her diet with foods that have the best effect on the functioning of the ovaries. These are liver, lean red meat, sea fish, dairy products.

Efficiency

In the first cycle, when ovulation is stimulated, a woman can become pregnant in about 15% of couples.

During the second and third cycles, the number of positive outcomes, when ovulation can be restored, reaches 70-75%. In general, the effectiveness of drug induction of ovulation is estimated at 70-80%. This is the number of couples who manage to eventually help get pregnant naturally.

The rest come to the aid of IVF, ICSI and other assisted reproductive techniques and techniques.

Possible consequences and complications

Stimulation is carried out with hormonal drugs, which would be wrong to underestimate the impact on the female body. The very induction during the cycle often causes pain and discomfort in women. Many complain that the lower abdomen is pulled and even that the ovaries hurt after stimulation. Almost everyone experiences "hot flashes" - hot flashes that come in waves.

One of the most dangerous consequences of stimulation is overstimulation., in which the growth of follicles occurs so rapidly that hyperstimulation syndrome develops. He most often can make himself felt for the first time on 3-4 days after the start of induction.

If signs of such a pathology appear at a later date - after 7-10 days of the menstrual cycle, then the syndrome proceeds quite hard, with vomiting, diarrhea, swelling of the limbs and face, a drop in blood pressure, and a sharp deterioration in well-being.

A woman may need qualified help in a hospital setting. Therefore, stimulation should be carried out by a doctor with extensive experience in reproductive programs, who will be able to timely control the processes occurring in the woman's body under the influence of hormones and make the right and informed decisions.

Often, a woman's infertility is due to her lack of ovulatory cycles. Hormonal disorders in this case are associated with insufficient ovarian activity. It is possible to conduct special therapy to restore their functions. Doctors approach the choice of drugs individually, taking into account the age of the patient. Stimulation of the ovaries for pregnancy planning is resorted to during the preparation of a woman for IVF, as well as in the case when ovulation is absent due to hormonal disorders or the woman's age is approaching menopausal.

Content:

What is the essence of the procedure

In order for conception to occur, ovulation is necessary, that is, the release of a mature egg from its surrounding shell (follicle). The rate of maturation and the likelihood of ovulation depends on the level of sex hormones, the production of which is regulated by the pituitary gland. The reason for the appearance of cycles without ovulation is a hormonal failure, in which eggs with defects are formed or follicles do not have time to mature during the cycle. Sometimes the problem is that a normal follicle cannot rupture, resulting in cysts. The appearance of cycles without ovulation is facilitated by the presence of inflammatory and infectious diseases of the genital organs, a sharp increase in body weight.

Problems with the maturation of follicles can be detected during the examination of a woman for infertility. Lack of ovulation is detected by measuring basal temperature, conducting blood tests for estrogens, progesterone, and pituitary hormones. Folliculometry is also used (ultrasound of the ovaries, which allows you to control the growth of follicles during several menstrual cycles).

Stimulation of the onset of ovulation when planning conception is carried out by the action of hormonal preparations on the pituitary gland, activating the production of follicle-stimulating (FSH) and luteinizing (LH) hormones in it.

Indications for stimulation

Its implementation is possible only if normal eggs mature in the ovaries, the woman does not have genetic abnormalities in development. Before starting treatment, it is necessary to know for sure that the sexual partner does not suffer from infertility.

Indications for ovarian stimulation for pregnancy planning are:

1. Preparation for IVF. Even if a woman has a regular cycle and no problems with the maturation of the follicles are found, preparation is still carried out. It consists in the complete stabilization of the hormonal background.
2. No ovulation in a young woman for at least 6 cycles.
3. The desire to accelerate the onset of pregnancy in a woman over 35 years of age, if ovulatory cycles appear extremely rarely.
4. The desire of a married couple to have twins. After stimulation of the ovaries, not one, but several eggs mature.
5. Obtaining healthy eggs for their subsequent freezing. This procedure is carried out if it is necessary to remove the ovaries, as well as when planning the onset of pregnancy at a later date.

Subsequently, the eggs can be used for artificial insemination.

Contraindications

Absolute contraindications to ovarian stimulation are the presence of hereditary pathologies or chromosomal disorders in a woman.

The procedure is usually denied to patients who decide to have a baby after the onset of menopause. At this age, the effect of hormones leads to a significant deterioration in the health of a woman, and can adversely affect the development of the fetus. In addition, the chances of successfully "growing" follicles are too small.

With polycystosis, stimulation is not performed if the patient, in addition, has obstruction of the fallopian tubes or there are other causes of infertility. The use of hormonal drugs greatly complicates the situation, since they have a lot of side effects. In order for ovulation to occur, a woman was able to conceive in the presence of polycystosis, a surgical method of treatment is used (for example, notches are made on the ovary to release a mature egg from it).

A contraindication to stimulation is also the patient's intolerance to the drugs used.

Stimulation is also not prescribed when diseases of the uterus, in particular, the endometrium, are detected. Due to the violation of its structure, the implantation of the embryo becomes impossible.

Relative contraindications are the presence of infectious and inflammatory diseases of the genital organs in a woman, as well as adhesions in the ovaries and one of the fallopian tubes. In this case, the procedure is postponed until the elimination of pathologies.

Side effects and complications

One of the serious consequences is the depletion of the ovarian reserve. The number of eggs that can mature during the reproductive period is strictly individual. Accelerating their maturation can lead to premature aging of the ovaries, which is fraught with the occurrence of early menopause, as well as diseases caused by hormonal disorders.

Note: Doctors warn that repeated stimulation is very dangerous. With each repeated procedure, the risk of complications increases more and more.

After stimulating ovulation, complications such as the onset of an ectopic pregnancy, the formation of cysts, the appearance of edema in them and an increase in size due to hyperstimulation, and ovarian apoplexy may occur. Possible disruption of the intestines, bladder, the appearance of severe pain in the ovaries and back.

Examination before stimulation

Before the appointment of ovarian stimulation for planning conception, a woman is examined to study the state of her general and reproductive health. Examination during the planning period of pregnancy includes:

• blood test for syphilis, HIV and hepatitis B and C;
• analysis of a vaginal smear for microflora, the presence of pathogens such as mycoplasmosis, gonorrhea, chlamydia, sexually transmitted diseases, as well as candidiasis and gardnerellosis;
• a blood test for antibodies to rubella;
• Ultrasound of the mammary glands;
• electrocardiogram;
• study of the patency of the fallopian tubes using ultrasound, laparoscopy and salpingography (X-ray using a contrast solution);
• hysteroscopic examination of the uterine cavity and examination of the state of the endometrium;
• study of the state of the uterus on different days of the cycle using ultrasound.

Among other things, blood tests are carried out for FSH, LH, estrogens, progesterone, thyroid hormones and others. They are done repeatedly also in the process of stimulation in order to control the hormonal background. A study of the sperm of the sexual partner is carried out to determine its quality.

Video: Reasons for the lack of ovulation. Methods for stimulating it with drugs

Conducting stimulation

The choice of drugs and their regimen is made individually according to the results of the examination and taking into account the duration of the woman's cycle. It is necessary to conduct 2-5 courses.

Warning: It is completely unacceptable when planning a conception to use drugs without a doctor's prescription, as well as a violation of the treatment regimen.

The following drugs are usually prescribed:

• gonadotropins (the pituitary hormones FSH and LH, which stimulate the maturation of follicles - menogon, menopur, pergonal);
• antiestrogenic agents that promote rupture of follicles and the onset of ovulation (clostilbegit, clomiphene, serofen, serpafar);
• drugs - analogues of hCG (human chorionic gonadotropin). They are introduced to stimulate the rupture of the follicle shell, which has reached 20 mm in diameter. Such drugs are pregnil, ovitrel, profazi.

The principle of ovulation stimulation when planning a pregnancy is that first, hormones are introduced into the body to “grow” the follicles, then to break them. After ovulation, progesterone-containing products are prescribed to maintain the viability of the embryo.

The moment of onset of ovulation is determined with great accuracy using ultrasound, conducting a study over several days of the first phase of the cycle. Just before ovulation, one of the hCG-based drugs is administered.

There are several incentive schemes.

Stimulation with clostilbegit

The action of this drug and its analogues is based on increasing the production of pituitary hormones (FSH, LH and prolactin) and reducing the sensitivity of estrogen receptors located in it and in the ovaries. Used in a strictly defined dose, the drug stimulates the growth and maturation of follicles with eggs. It is taken starting from 2-5 days from the beginning of menstruation (based on a 28-day cycle) for several days according to an individual scheme.

From the 16th day, progesterone-based drugs (utrogestan or duphaston) are additionally prescribed. This hormone contributes to the creation in the uterus of the conditions necessary for the successful fixation of a fertilized egg and the preservation of pregnancy. Such funds are accepted within 2 weeks.

Just before the start of the expected menstruation, a woman can use a pregnancy test to make sure that conception has occurred. To confirm a positive result, about 10 days after the delay, an hCG test is performed. Pregnancy is also confirmed by ultrasound.

When using this method of stimulation, complications may occur. Suppression of estrogen production leads to a violation of the composition of the mucus produced by the glands located in the cervix. Therefore, spermatozoa often die before they reach the fallopian tubes. In addition, due to the lack of estrogen, the development of the endometrium slows down. If its thickness by the time of fertilization of the egg is insufficient, the embryo will die, failing to attach to the wall of the uterus.

In order to minimize the risk of such complications after the onset of ovulation, estrogen-containing drugs, such as proginova, are prescribed.

Stimulation with gonadotropins

If treatment with antiestrogens does not help, they resort to another scheme for stimulating ovulation. A woman is prescribed injections of gonadotropins to create a hormonal background similar to natural. In this way, the sequential course of the processes of the cycle is imitated and the body is prepared for the onset of pregnancy. Treatment is carried out within a week, starting from the 2-3rd day of the cycle.

Combined stimulation scheme

In some cases, the doctor combines various schemes for ovarian stimulation. At the same time, it begins with taking clostilbegit on the 2nd-5th day of the cycle (for 5 days), and then supplemented by taking gonadotropins for 1 week. After an injection of hCG and subsequent sexual intercourse, a woman is prescribed progesterone preparations.

Video: How the ovarian stimulation scheme is chosen

The use of folk remedies

Traditional medicine doctors recommend using decoctions and infusions of phytoestrogens plants to stimulate the ovaries, which contribute to the normalization of hormonal levels. Sage infusion, decoctions of plantain seeds, rose petals, and quince juice are especially popular.

The happiness of every woman is known in motherhood, but it is not always so easy. Many women are not able to get pregnant for many reasons, so they are forced to seek help from specialists. To date, there are a huge number of clinics in which doctors are ready to help women find out what real motherhood is.

One of the modern effective ways to accelerate fertilization is ovarian stimulation for pregnancy planning. It is performed by taking hormonal drugs, strictly selected for each specific case. Very often, this method of increasing the chances of conception is used for artificial insemination or in vitro fertilization, but with similar success it can be used in the absence of ovulation due to age or hormonal failure in a woman. In any case, the procedure has a positive effect.

Possible problems

The natural process of egg formation consists in its full formation, after which the follicle enters the fallopian tube and bursts, releasing the egg. Violation of this process leads to the formation of problems with conception.

The reasons may be:

• serious gynecological diseases;
• hormonal disruptions;
• excess weight;
• infectious diseases and much more.

Most often, ovulation is absent due to hormonal disruptions in the body of a woman.

Operating principle

Stimulation of the ovaries for planning conception is carried out by taking hormonal drugs to normalize the natural menstrual cycle, during which it will be possible to fertilize a mature egg. It can be done naturally or artificially.

Almost half of the cases of using this method of stimulation has a successful ending, but this method is suitable only for women whose reproductive organs are absolutely healthy, and problems appear due to malfunctions in the hormonal system of the body. But even in this case, many do not dare to use this method, since taking hormonal drugs has a number of side effects that may occur. Among the negative consequences of ovarian stimulation for pregnancy planning (reviews from real patients confirm this), pain in the ovaries can be called. The procedure can also lead to the depletion of the egg reserve, which has certain consequences that affect the general condition of the woman's body.

Dosing regimen

Only a qualified doctor is able to prescribe the medicines necessary for each specific case, since even for this he needs to familiarize himself with a number of results of examinations and analyzes of a woman. The dosage of drugs is also selected individually, all treatment processes are combined only in that they begin their effect on the body only after the third or fifth day from the start of the menstrual cycle.

Most often, ovarian stimulation for pregnancy planning is carried out by intramuscular injection of the drug. This choice is explained by the rapid effect of gonadotropic drugs on the body, but other methods can be used to speed up conception:

• tablets;
• antiestrogen substances;
• recombinant drugs.

To evaluate the effectiveness of the chosen method, the entire process of egg maturation is strictly controlled by specialists with the help of regular ultrasound examinations. As soon as the egg fully matures and the follicle bursts, the woman is given an injection of human chorionic gonadotropin, which contributes to the further favorable course of pregnancy. In the case of natural fertilization, conception occurs immediately after this. If it is planned to carry out in vitro fertilization, then the next day it is necessary to take the egg.

Other options

Stimulation of the ovaries for planning conception by the described method is the most commonly used by doctors, but there are also cases when it does not have the desired effect on the body. In such cases, women increase the dose of prescribed drugs or recommend other medications. In any case, the scheme will be identical:

• stachala taken gonadotropins;
• after them - follicle-stimulating hormone in recombinant form;
• the third step is antiestrogen drugs;
• the final one is chorionic gonadotropin.

Each of the stages has multiple options for possible prescribed drugs. In the absence of results after applying each, it will be necessary to retake tests and undergo examinations for a more accurate selection of the next set of measures. At the same time, you should know that conception very rarely occurs immediately in the first month of taking medications, usually you have to carry out 2-3 courses of treatment until a positive result is obtained.

Most popular option

Most often, ovarian stimulation is carried out for pregnancy planning with Clostilbegyt. The active substance of the drug acts directly on the ovaries, provoking the accelerated development and maturation of follicles in them. Stimulation is carried out by the action of the drug on the hypothalamus and pituitary gland to produce the hormones needed by the body. Means "Klostilbegit" is produced in the form of tablets, has analogues. The course of taking the drug is prescribed by a doctor and lasts no more than five days. Usually the start of the reception coincides with the second day of the cycle, but the exact date depends on the level of hormones in the patient's body and the characteristics of her natural cycle. That is why you should not use such drugs on your own, because improper use of hormones can lead to negative consequences for the whole body. For the same reasons (due to the individuality of each organism), ovarian stimulation for pregnancy planning by folk remedies is not carried out.

After taking the drug and the start of the cycle, you should wait for the expected date of ovulation and a day before it, inject hCG to stimulate the mature follicle to burst and release the egg.

The final stage is the intake of medications that contribute to the retention of the fetus in the body in the event of pregnancy. Among these, such funds as "Dufaston", "Kraynon" and "Utrozhestan" are distinguished. They are recommended to be used from about the sixteenth day after the start of the cycle. Other estrogenic drugs may also be included in the scheme, on the recommendation of a doctor. In the absence of a positive result of using this method, a woman should re-take tests and switch to taking gonadotropins that mimic the natural processes of the female body.

Implementation of treatment

Any schematic stimulation of the ovaries should be carried out only after a thorough examination of the female body and identifying the cause of problems with conception. The fact is that some diseases can adversely affect the intake of hormonal medications and not only not give the desired result, but also worsen the general state of health.

Therefore, before starting stimulation, the following tests should be passed:

• for the presence of HIV and other sexually transmitted diseases;
• for TORCH infection;
• all tests to draw up a picture of the hormonal state of a woman's body;
• cytology test;
• analysis of the microflora of the vagina.

In addition, it is necessary to undergo a number of examinations, including an electrocardiogram, an ultrasound examination of the mammary glands and a test for the patency of the fallopian tubes. All this applies to mandatory procedures, but in some situations, ovarian stimulation for pregnancy planning may require additional research (hysteroscopy or laparoscopy).

In addition to all the above tests for a woman, the partner also needs to undergo an examination. This is necessary to confirm the activity of spermatozoa and exclude male infertility. Only after a thorough study of all the results obtained, the specialist prescribes an individual program to stimulate the work of the female reproductive system.

Prohibitions for use

Stimulation of the ovaries for pregnancy planning is not allowed for everyone, which is why such a thorough examination is necessary before its implementation.

It is strictly forbidden to use this method to conceive a child for women with:

• somatic deviations;
• obstruction of the fallopian tubes;
• hereditary diseases;
• genetic disorders;
• diseases of the kidneys and liver;
• diseases of the cardiovascular system.

In addition, the prohibitions apply to other, less significant violations in the body. If they are present, conception, the process of stimulation itself and further pregnancy can fail. Such disorders include any inflammatory diseases of the reproductive system, including sexually transmitted infections. With obstruction of only one tube, any cystic formations, including polycystosis, ovarian stimulation (reviews of experts confirm) is contraindicated. To obtain a positive result, you must first solve the problem with these diseases, and then proceed to stimulation.

Side effects

In addition to a number of contraindications, there are a number of negative consequences of ovarian stimulation for pregnancy planning. Since taking hormonal drugs affects the entire body as a whole, this often provokes hyperstimulation of the reproductive function. The reason for this effect may be an incorrectly selected dose of the drug or too violent reaction of the body to a certain substance. In any case, this once again confirms the need to take medications only on the recommendation and under the supervision of a doctor.

Besides:

• ovaries after stimulation very often hurt;
• a woman has problems with defecation;
• general health worsens;
• fluid accumulates in the body, which leads to swelling;
• many neoplasms in the form of cysts are possible.

The last consequences of ovarian stimulation relate to the procedure during the presence of polycystic disease in the body. In such cases, further surgical intervention may be required. However, in some cases, cysts can resolve on their own. In some cases, the consequences of hormonal stimulation can be an ectopic pregnancy.

Twins - happiness or a side effect?

Very often, in one cycle, several eggs mature in a woman at once, but with natural fertilization, only one of them remains. In the case of stimulation of pregnancy with hormonal drugs, both eggs do not have an advantage over each other and provoke a multiple pregnancy.

Age changes

Since every woman has a certain reproductive age, at the end of which it becomes impossible to conceive a child, after forty years the issue of pregnancy becomes very acute. For women at this age, the likelihood of getting side effects becomes higher, as well as the likelihood of multiple pregnancies. At the same time, stimulation is an effective method for conception at this age, and this chance should not be neglected.

Especially often this procedure is recommended for older women who decide on artificial insemination. An extracorporeal procedure is necessary for ladies after forty years, since she does not have her own viable eggs and she needs to turn to donors, especially if her partner has a sufficiently high-quality seminal fluid. The side effect in this case in the form of pain soon disappears.

Stimulation of the ovaries (patient reviews indicate this) after the age of forty gives positive results with timely access to a qualified specialist in this matter. The main thing is not to delay the implementation of the decision, because with each cycle there are fewer and fewer eggs.

Conclusion

In any case, before carrying out the procedure, in addition to passing the listed tests, you should make sure that there is no allergic reaction to any of the substances used in the method. Such a step will eliminate many negative consequences. It is also necessary to pass the required examination in advance.

Every year, this procedure helps many women to have a full-fledged family, give birth to long-awaited children and realize themselves as real mothers. Today, difficulty conceiving is no longer a major problem for most women at any age.

But be that as it may, this process must be taken very seriously. After all, not only successful fertilization, but also the health of the future mother depends on the right clinic and doctor.

A woman, like no one, is acutely experiencing a depressing feeling from the impossibility of becoming a mother, having a child. Medicine offers many options for solving this problem, including ovarian stimulation for pregnancy planning. This method is popular among women who cannot get pregnant.

Indications for stimulation

There are a number of reasons why a doctor prescribes ovarian stimulation. Each of them has its own direction.
The procedure is carried out:

• before in vitro fertilization;
• in the absence of ovulation in several cycles in a row;
• if the age of the spouses is more than 35 years;
• during intrauterine insemination;
• if within a year the couple cannot conceive a child on their own;
• before freezing the cells for their further fertilization.

If a man is infertile, it makes no sense to stimulate ovulation. In case of obstruction of the fallopian tubes, the procedure is performed, but only after laparoscopy. Violation of this order leads to an ectopic pregnancy.

Preparation for the procedure

To give birth to a healthy baby, ovulation stimulation is a necessary step before IVF. The doctor prescribes an examination showing whether there are any obstacles from the female reproductive system for stimulation. First of all, the patient receives a referral for tests that exclude health problems.

Necessary examinations

For stimulation, the couple must mutually pass tests.
Before the procedure, surrender:

• tests for the presence of genital infections;
• a blood test for the Rh factor;
• clinical blood test;
• blood chemistry;
• smear on the microflora of the vagina (in women);
• tests for TORCH infections (in women);
• hormone tests (in women);
• spermogram (for men).

In the case of an acceptable result, the doctor prescribes further examination.
A woman undergoes the following examination:

• vaginal examination;
• Ultrasound of the mammary glands;
• Ultrasound of the small pelvis;
• cardiogram;
• laparoscopy or hysteroscopy (if necessary).

If necessary, couples are assigned a compatibility test.

Stimulation of the ovaries is carried out if, according to the results of the tests, it is clear that there are no pathologies on the female side, infertility - on the male side.

Methodology

The essence of stimulation is the normalization of hormonal levels - the restoration of ovulation with the help of drugs. In most cases, the use of drugs helps to stir up the ovaries. Based on the results of the examination, the doctor individually selects a medication for each patient.
It is worth considering that nature provides for a certain reserve of eggs. With frequent stimulation, this reserve is depleted, which adversely affects the female body.
Lack of ovulation can be caused by many factors: hormonal imbalance, overweight or underweight, some gynecological diseases. To restore the menstrual cycle, hormonal stimulation is used to ensure the normal formation of an egg. This method is applicable for healthy women in whose body, due to hormonal failure, follicles do not burst or develop.

Ovarian stimulation drugs

For the full maturation of the egg, the patient takes a hormonal drug chosen by the attending physician.
To prepare the endometrium and stimulate ovulation, the following are most often used:

• recombinant HCG: Puregon, Gonal, Gonal-F - drugs similar to follicle-stimulating hormone;
• gonadotropins: Menopur, Pergonal, Menogon - contain the hormones FSH and LA, which are responsible for the onset of ovulation and egg maturation;
• preparations based on hCG: Pregnil, Ovitrel, Horagon, Prophase, imitating the ovulatory peak;
• antiestrogenic medicines: Clostilbegit, Serofen, Kromifen, Clomidit - reduce the level of estrogen in the body, which allows you to increase the synthesis of gonadotropic hormones.

Other medicines with the same purpose may also be used.

Important! Do not take medications that stimulate ovulation on your own. Only a doctor can choose a drug and only after a complete examination of the patient.

In no case is it recommended to independently change the infertility treatment regimen prescribed by the doctor. This can lead to serious consequences, for example, to the opposite effect. Self-stimulation of the reproductive female organs is possible only with the help of folk remedies.

Carrying out the procedure

Stimulation of ovulation can be carried out according to one of three schemes. Each of them is carried out by two groups of drugs: antiestrogens and gonadotropins. The choice of the drug and the selection of the scheme depends on the age of the patient, her body weight and possible causes of infertility.

Note: only medicines approved in a particular country are used.

Scheme one

The doctor prescribes drugs that increase the production of gonadotropic hormones. Such treatment can make the ovaries work properly.
The procedure is carried out on the 2nd-5th day of the menstrual cycle. The doctor prescribes 1 tablet of Clostilbegit for 5 days.
With the usual duration of the female cycle of 28-30 days, ultrasound is performed on days 7-11 or 14-16 of menstruation. If the duration of bleeding differs from the standard, the doctor prescribes an ultrasound at his discretion. This helps to track the growth and release of a mature egg.

Attention! Some patients report pain in the ovaries after stimulation. In rare cases, pain can be caused by a growing cyst, so you should tell your doctor about any changes in the body.

On the 14-16th day of the menstrual cycle, when the follicles begin to mature, the expectant mother is injected with a drug based on hCG.
The medication helps the egg to exit the follicle at the right time.
For greater effectiveness over the next 14 days, you should actively have sex during stimulation.
From day 16, the expectant mother begins to take progesterone-based drugs that help prolong and maintain pregnancy.
At the next stage, the woman takes an anti-estrogenic drug. Its purpose is to help sperm get to the egg, and further help it attach to the walls of the uterus.

Important! The woman's menstrual cycle affects the duration of stimulation.

The final step is taking medications based on estrogen. If pregnancy does not occur, during the second stimulation, the doctor increases the dose of anti-estrogenic drugs. If pregnancy has not occurred even after the second stimulation, the doctor switches to another treatment regimen after re-testing.

Read also Causes of ovarian pregnancy and its possible consequences

Scheme two

The doctor prescribes medications from the group of gonadotropins, aimed at stimulating the work of the female gonads, controlled by the pituitary gland. The drug is prescribed from 2-3 days after the onset of menstruation. Ultrasound control is carried out on days 6-7, 9-11 and 13-16, due to which the work of the ovaries is monitored and the required dosage taken by the patient is monitored.
In rare cases, such a scheme does not bring the desired results. If pregnancy has not occurred, the couple must undergo an additional examination under the direct supervision of a doctor.

Scheme three

Contains a combination of the first and second schemes at the same time. The patient starts taking Clomiphene from the 2nd to the 5th day of menstruation for 5 days. Then, from the 5th to the 7th day of the cycle, gonadotropins are introduced. This is followed by an injection of hCG. For a certain time, a married couple is recommended to maintain active sexual relations. The patient takes drugs based on progesterone to consolidate the result.

Contraindications

In some cases, stimulation is contraindicated for women in order to improve ovarian function. Contraindications are divided into significant and less significant.
Significant contraindications include:

• poor patency of the fallopian tubes;
• gene or chromosomal abnormalities of a genetic nature;
• various chronic diseases;
• menopause;
• problems with the endometrium;
• polycystic;
• partner infertility.

Stimulation is not carried out if those who wish to have a child suffer from at least one of the above diseases.
Less significant contraindications include:

• inflammation of the female genital organs;
• poor patency of one of the fallopian tubes;
• sexually transmitted infections;
• cystic neoplasms in the appendages;
• allergy to the components of the drug.

All cases are individual, and whether to stimulate or not, the medical commission decides after a complete examination of the patient.

Consequences of stimulation

Stimulation of the ovaries can lead to certain problems during pregnancy. It is necessary to know in advance all the possible consequences that await a woman after undergoing the procedure.
Stimulation can lead to the following consequences:

• enlargement of the ovaries;
• pain in the appendages;
• change of mood;
• bloating;
• cyst formation;
• problems with bowel movements;
• spontaneous miscarriage;
• fetal death in multiple pregnancy;
• ectopic pregnancy;
• early birth;
• ovarian hyperstimulation.

In 10% of cases, multiple pregnancy is possible, which occurs most often after taking hormonal drugs. In one cycle, several eggs can develop at once.