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Patients who find themselves in a difficult situation tend to trust their doctor. But very often, women are prescribed a course of stimulation with clostilbegit, which is not always appropriate. Restoration of ovulation should be started only after a full course of preliminary examination of both partners. It is this approach that will indicate the competence of the attending physician.

Patients, not knowing all the features of the absence of ovulation and the methods of its stimulation, trust the opinion of a specialist. They agree to conduct any course of treatment to achieve the desired goal - pregnancy. Women agree to stimulation with clostilbegit without being familiar with its necessity, features and consequences.

Ovulation is usually stimulated with hormonal drugs. Such a procedure is carried out in cases where a woman’s ovaries do not mature enough for the conception of a full-fledged egg. For each woman, the type of drug is selected individually, as well as its dosage. Thanks to this stimulation, one or more eggs are formed in the body. After ovulation is called, fertilization of a mature egg becomes possible.

In order to achieve the restoration of ovulation, it is necessary to determine the cause of its absence. If the reason for the lack of ovulation has not been established before starting stimulation with certain drugs, the treatment may not bring the desired result.

Methods for determining the absence of ovulation

Hospitals often began to prescribe hormonal stimulation unnecessarily. This approach is not only inappropriate in some cases, but can also harm the body of the expectant mother. In order not to undergo an unnecessary course of treatment, determine for yourself whether you are ovulating or not.

How to check it so that the result is one hundred percent? You should not make a diagnosis of "lack of ovulation" based only on the results of the basal temperature chart, even when maintaining the chart for several cycles. The exact answer can only be given by:

• Comprehensive examination by a doctor;
• Testing for hormones;
• Carrying out continuous ultrasound monitoring of the degree of development of follicles. This observation must be carried out over several menstrual cycles;

Tests for hormones

You need to check the level of hormones several times. This approach will help to avoid an erroneous result (due to the fault of the laboratory) and determine the absence of a problem in the body. It is also worth considering the factor that the level of hormones in the female body is not stable. Each cycle may have a different level indicator. The test results are also influenced by factors such as: stress, nutrition, etc.

Pay attention to the level of hormones such as:

• Thyroid hormones;
• male hormones;
• Prolactin.

If their level does not correspond to the norm, then it is not recommended to start stimulation. Deviation from the norm of these hormones can prevent ovulation. It is possible that after the stabilization of the level of these hormones, ovulation will recover on its own.

Ultrasound monitoring is used to establish the absence of ovulation, as well as determine its cause. With a 28-day cycle, you can do the first ultrasound as early as 8-10 days after the last menstruation has passed. If the menstrual cycle is longer, then you need to do an ultrasound later.

After the first ultrasound examination, it is necessary to undergo an ultrasound examination every 2-3 days. The doctor prescribes each subsequent ultrasound based on the condition of the uterus, as well as the ovaries. An ultrasound cycle is carried out until ovulation occurs or critical days begin.

When conducting an ultrasound study, information is collected about the state of development of follicles in the ovaries:

1. Lack of follicle development;
2. The development of the follicle is observed, then the development stops. The follicle does not reach the desired size and begins to regress;
3. The development of the dominant follicle is observed, which stops, and the follicle does not reach the required size, it begins to luteinize. Ovulation does not occur regardless of the fact that the level of progesterone is normal, and the cycle is constant;
4. The development of the dominant follicle is observed, it grows to the desired size, but its further development does not occur for certain reasons. This is followed by regression of the follicle, as well as the formation of cysts;
5. The development of the follicle, the appearance of the corpus luteum and the onset of ovulation are observed. In cases 1 to 3, it is necessary to conduct regular ultrasound observations, in the 4th case, it may be enough to prescribe and perform an injection of hCG in time to cause rupture of the follicle.

Indications for stimulation

In the absence of ovulation in women, they are prescribed stimulation. Usually, a drug challenge for egg maturation is prescribed:

• Couples who have not been able to conceive a child in the usual (natural) way for a period of more than a year;
• Couples over 35-49 years of age;

To conduct drug stimulation, a competent doctor prescribes a series of tests and examinations for a couple:

1. Blood test for HIV;
2. Blood test for Hepatitis B, C;
3. Blood test for syphilis;
4. Gynecological smears in a woman;
5. The patency of the fallopian tubes is assessed;
6. Performing a spermogram.

Contraindications for stimulation:

1. Obstruction of the fallopian tubes;
2. Cases of male infertility;
3. With uterine pathology;
4. Adnexitis (acute inflammatory process);
5. Age (relative factor).

Recovery rules

1. Before starting stimulation, it is necessary to have the results of the husband's spermogram (IVF / ICSI) on hand. They should be pretty good, or at least suitable for natural conception.

   The delivery of these tests by a man should be carried out in recent periods. The spouse must be tested regardless of the results that were in the past year, and also regardless of the factor of having (he) children. If your doctor prescribes the delivery of a spermogram analysis by a sexual partner only after several unsuccessful stimulation courses, change your doctor. This approach speaks of his incompetence in solving this problem.

2. Before performing the restoration of ovulation, it is also necessary to undergo a study of the fallopian tubes for patency (HSG) or laparoscopy (with the exception of those cases when IVF / ICSI is necessary).
3. Any stimulation must be carried out under the strict supervision of a doctor, as well as constant ultrasound monitoring, which is carried out to monitor the body's response to the stimulation process and the development of follicles.

Stages of stimulation

The decision on the start date and duration of stimulation is made by the attending physician. It depends on the condition of the uterus, as well as the patient's ovaries. So stimulation with clostilbegit begins on the 5th day, and ends on the 9th; stimulation with gonadotropins begins on the 2nd day, and ends after about 10 days.

A few days after you have begun the restoration of ovulation, you need to conduct the first ultrasound. Then they are carried out every 2-3 days. The timing of their conduct is determined by the state of the uterus and ovaries.

Stimulation continues until the follicle reaches the required size (20-25 mm). After reaching these dimensions, an hCG injection is prescribed. Its dosage is set by the attending physician (from 5000 to 10000 IU). The purpose of this injection is to stimulate the ovulation process, as well as to prevent the regression of the developed follicle and the occurrence of follicular cysts.

In most cases, the onset of ovulation begins 24-36 hours after the hCG injection. Ovulation is confirmed by an ultrasound examination. At the beginning of ovulation, the necessary support for the ovaries is prescribed with injections of progesterone or utrogestan.

Depending on the results of the spermogram, the doctor sets the required frequency of sexual intercourse during stimulation. It is usually recommended to have sexual intercourse every other day (in some cases every day), but only after the hCG injection and right up to the formation of the corpus luteum, which indicates the onset of ovulation.

Application of Clostilbegit (Clomiphene)

Clostilbegit (Clomiphene) has become the cheapest and most common drug used to stimulate ovulation in women. Initially, this drug was developed as a contraceptive, but the result was completely opposite.

Pay attention to the side effects of this drug. An important side effect is the antiestrogenic effect. It is this fact that can harm the onset of pregnancy. Estrogens play an important role in the overall process of conception. Among their actions are:

1. Stimulation of the secretion of cervical mucus. It is a favorable environment in which the life, movement and nutrition of spermatozoa is performed;
2. Stimulation of the release of luteinizing hormone;
3. Promoting the regeneration and growth of the endometrium.

If there is a deficiency of estrogen, the onset of ovulation becomes impossible, which means that pregnancy will not occur.

Less dangerous side effects include:

• Dizziness;
• Drowsiness;
• Headache;
• Insomnia;
• Depression;
• Nausea;
• Increase in body weight;
• Allergic dermatitis.

The list is pretty big. The harm outweighs the potential benefit of the drug. There is also a very high risk in the development of the fetus. The use of this drug does not in all cases contribute to the onset of pregnancy: 2635 cases of pregnancy out of 7578 patients who used it. The survival rate of children is 98.16% - at the birth of one child, and 83.25% - at the birth of twins. (Drugs.com data ).

Warning! If you have completed 3 courses of treatment with clostilbegit, and the result remains negative, i.e. without the onset of ovulation, you need to change the methods of treatment, after passing an additional examination of the body.

Abuse of this drug is marked by early exhaustion of the ovaries, as well as early menopause. Early depletion of the ovaries adversely affects the further treatment of infertility. It is also not recommended to undergo treatment with this drug for women who have problems with the growth of the endometrium.

Side effects of stimulation

Any drug treatment has its own side effects. Likewise, stimulation does not just go away. Common side effects include the following:

• The appearance of cystic formations;
• ovarian hyperstimulation;
• Early exhaustion of the ovaries;
• Overweight gain;
• The onset of multiple pregnancy;
• Problems of the gastrointestinal tract (Gastrointestinal tract);
• Problems of the CNS (Central Nervous System);
• Ovarian apoplexy (rupture);
• Hormonal disorders.

Before deciding to start a course of stimulation, many doctors recommend:

• Change your lifestyle;
• Start eating right
• Explore options for restoring health with natural remedies.

Folk methods of stimulation

Many women prefer to stimulate ovulation with natural methods. In order for ovulation to occur, it is customary to use infusions of 3 medicinal herbs:

• Sage;
• Red brush.

You can buy these herbs in pharmacies.

For stimulation with infusions of these herbs, you must:

1. Drink an infusion of sage 3-4 times a day. 1 tablespoon is steamed in a glass of boiling water. Its use contributes to the maturation of the egg and the growth of the endometrium;
2. Drink an infusion of a boron uterus. This herb contains the main hormone needed during early pregnancy, progesterone. A decoction of this medicinal plant is prepared in the same way as sage;
3. The use of infusion of the red brush. It is practical in the treatment of many gynecological diseases.

Also known options for the use of such folk remedies as:

• A decoction of rose petals containing vitamin E;
• Aloe and quince juice;
• Mummy;

It is advisable to combine stimulation with folk remedies with medical supervision, as well as regular ultrasound examinations.

Stimulation and vitamin therapy

When taking a course of stimulation, you need to think about proper nutrition, as well as providing the body with the necessary vitamins and minerals. A woman preparing to become a mother should eat foods containing:

• folic acid;
• Potassium iodide (found in iodized salt);
• Vitamins C, E, A, etc.;

Stimulation of ovulation is a course of treatment that brings the expected result in 70% percent. The patient himself must decide whether to carry it out with the method recommended by the doctor or not. It is necessary to compare all the pros and cons and take this procedure seriously.

Remember: without establishing the cause of the lack of ovulation (through a comprehensive examination), do not resort to drug stimulation. Get treatment only from a competent specialist in order to avoid harm to your health.

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: 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 GnRH 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.

Conception is possible when an egg matures in the middle of the menstrual cycle. If there are violations of ovulation, its forced stimulation will be required.

The procedure has helped many couples conceive a child. It is aimed at the growth of the dominant follicle and is performed by medical or alternative methods.

When and who may need to stimulate ovulation

An indication for the procedure is anovulation - the absence of mature female germ cells. Pathology is caused by endocrine disorders (low levels of AMH, FSH and other hormones), depletion of the ovarian follicular reserve, damage to the hypothalamic-pituitary system.

In PCOS (polycystic ovary syndrome), the lining of the ovaries is thickened and contains many cysts. Because of this, the follicle does not rupture and ovulation does not occur. Induction with hormonal preparations is needed.

The procedure is performed for those couples who have not become pregnant for more than a year with regular unprotected sex. If the age of the spouses exceeds 35 years, the gynecologist prescribes induction after six months of unsuccessful attempts at conception.

In the case of late ovulation, the egg does not have time to mature. Conception with such a violation is impossible. At the stage of pregnancy planning, hormonal treatment is carried out, with which the female germ cell leaves the ovary in a timely manner.

The procedure is often performed at the same time as artificial insemination or IVF. They are made to increase the chance of getting pregnant with endometriosis and polycystic ovaries.

Contraindication for ovulation stimulation is male infertility. With an inferior morphology of germ cells according to Kruger, the procedure does not lead to the desired result.

Is induction harmful? In most cases, no. The doctor finds out the cause of the pathology, then eliminates the etiological factors.

Stimulation is dangerous if a woman has a blocked fallopian tube. This leads to an ectopic pregnancy. Therefore, you first need to prepare: to do a laparoscopy, which eliminates the adhesive process.

How to stimulate ovulation - proven methods

Successful induction of the ovulatory phase is calculated for 6 monthly cycles. Over time, take a break in treatment. A woman undergoes an extended examination to identify the cause of the pathology.

Getting pregnant with health problems is quite difficult. In many cases preparation is required. Sometimes treatment is delayed for a year or longer.

Having diagnosed the cause of infertility, the doctor prescribes individual conservative therapy and changes the usual diet with lifestyle. How many times the induction is carried out is determined by the specialist.

Method 1. Medical approach

Only a doctor has the right to choose a drug. He prescribes the daily dosage and determines the drug interaction.

The right treatment regimen gives a stable result. The patient will soon become pregnant.

Table: "List of drugs that stimulate ovulation":

Method 2. Folk methods

Alternative medicine methods are widely used by women for egg maturation. They are effective if the main cause of the pathology is eliminated in time.

Essential oils are a natural stimulant for egg maturation. Use compositions of tea rose, basil, cypress, lavender, sandalwood and anise.

In the reviews of women who became pregnant using alternative methods of treatment, there are recipes for herbal infusions. The following plants are suitable for induction of the ovulatory phase.

Sage tea

Place 1 tbsp. l. herbs in a thermos, where then pour 1 cup of boiling water. Infuse for half an hour in a hermetically sealed container.

Start drinking the drug from the 5th day of the menstrual cycle and continue for about 10-14 days. Take 1 tbsp. l. morning, afternoon and before bed. The recommended course of admission is 3-4 months or until the onset of conception. To enhance the effect, add 1 tbsp. l. linden flowers. They are saturated with substances similar to female sex hormones.

Sage with upland queen

Women respond positively to the combination of herbs. Her recipe is simple.

Boil the sage. The decoction is applied in the first half of the menstrual cycle 4 times a day. At this time, the egg matures. In the 2nd half of the cycle, brew the boron uterus. The herb contains progesterone. He will support the onset of pregnancy. You can use the plant along with red brush grass.

psyllium seeds

Pour the ingredient with 200 ml of water and simmer over low heat. When the product boils, let it sweat on the stove for 5 minutes. Leave for at least an hour. Once time has passed, strain the solution. Drink 30 ml before meals. Start using the drug from the first day of the cycle. The duration of admission is 21 days.

Rose petals

The product contains a large amount of vitamin E. The substance actively affects the functioning of the ovaries.

To prepare a decoction, you will need 20 g of fresh petals. Put the product to boil in a water bath. After 20 minutes, remove the decoction from the heat and leave for at least an hour. The course of treatment is 1-2 months. If a man has problems with seminal fluid, he is given a decoction of red petals. For women, a potion is prepared from white or pink flowers.

Sagebrush

Let it brew 1 tbsp. l. herbs in 300 ml of water in a sealed container. Then bring the product to a boil and strain. Take half a glass in the morning and evening.

Tea with oregano

Prepare 1 tsp. herbs and pour 1 cup boiling water over it. Take decoction daily instead of tea.

Treatment with leeches is widely used as part of the complex therapy of polycystic and multifollicular ovaries. The procedure helps to start recovery processes in the body, stimulates metabolism and improves microcirculation in the small pelvis.

Method 3. Vitamin therapy

At home, the expectant mother can return ovulation with vitamins. Such treatment includes the use of folic acid, tocopherol, vitamin A and ascorbic acid.

Doctors recommend eating foods high in nutrients. Try adding pumpkin, carrots, spinach, strawberries, dates, vegetable oil, fresh juices, pumpkin seeds, and sesame seeds to your meals. Avoid alcohol completely.

Take substances according to the following scheme:

1. Vitamin B: prolongs the luteal phase, provokes the growth of the endometrium and the maturation of oocytes. Drink from the 5th day of the menstrual cycle for one month.
2. Vitamin E: stimulates the maturation of the corpus luteum, supports the ovulatory phase, increases the production of progesterone. Take from 15 days from the start of monthly discharge.
3. Vitamin A: promotes the maturation of follicles and regulates the volume of cervical fluid. Assign in the first half of the cycle.
4. Vitamin C: restores hormonal levels and prevents the development of genetic abnormalities in the fetus. Drink after ovulation on days 25-30 of the cycle.

Doctors prescribe Inofert to women with infertility. It is especially suitable for patients after 35 years. The drug causes ovulation and prevents the development of genetic abnormalities in the child.

Treatment occurs in parallel with drug or non-traditional methods of induction. Soon there will be new periods. Vitamin therapy continues for at least 3 months.

Possible consequences and complications

Women who have experienced ovulation induction respond differently to the sensations. Some do not feel any changes, others complain of complications.

With pathologically enlarged ovaries, the following symptoms may occur:

• bloating;
• migraine;
• nervousness;
• increased sweating and hot flashes;
• pain in the appendages;
• absence of menstruation.

Even if the pathogenic factors have been eliminated, the health problem may remain. Effects on the body are not excluded.

The most dangerous conditions:

• multiple pregnancy;
• ovarian rupture;
• pathological childbirth;
• death of the fetus inside the womb;
• spontaneous abortion at an early stage;
• ovarian hyperstimulation syndrome with increased fibrinogen, D-dimer;
• ectopic pregnancy.

To avoid adverse effects, do not try to stimulate ovulation on your own. Follow all doctor's instructions exactly.

Features stimulation for IVF

In vitro fertilization is performed when conception naturally does not occur for a long time. The cost of reproductive technology is quite high - from 100 thousand rubles.

Fertilization is carried out outside the body of the expectant mother. For the procedure to be successful, a significant amount of quality oocytes is required. Not all eggs taken are suitable for fertilization. Not all developed embryos are suitable for implantation in the uterus. That is why hormonal therapy should be chosen especially carefully.

The doctor changes the menstrual cycle in order to select the female sex cells at the right time. The specialist suppresses the formation of his own hormones. During a short or long protocol, the reproductive system is transferred to drug regulation.

On the 3rd-5th day of the menstrual cycle, the specialist induces the production of eggs with large doses of hormones (Menopur, Metipred). A woman is given an ultrasound diagnosis to evaluate the result of therapy. The more often the procedures are performed, the less the stock of oocytes becomes.

When the dominant follicle matures, the patient receives an hCG preparation. The main difference between in vitro fertilization is the provocation of superovulation. This is a huge stress for the female body. A day later, the doctor must take the oocyte sampling.

In the video, the specialist talks in detail about the stimulation of ovulation during IVF:

Doctors say that after the procedure, several follicles mature at the same time. 2 or more eggs are released ready for fertilization. This can lead to the conception of twins.

Conclusion

Just 20-30 years ago, a woman's failure to ovulate meant her inability to conceive. The modern level of medicine allows for successful treatment of this condition. The family acquires healthy children without consequences for the mother's body.

The ovulatory phase can be stimulated by medication and alternative methods. The procedure is carried out under the strict supervision of a doctor. Treatment will not cause consequences and complications.

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.

1. Stimulation of the ovaries. The main component of the drugs is follicle-stimulating hormone.
2. 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.
3. 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.

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 used 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. The absence of 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 stimulation of 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, 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 (within 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.