Stimulating ovulation for planning pregnancy: drugs and results

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

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

What it is?

Every month or almost every month, ovulation occurs in the body of a healthy woman capable of conceiving. 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.

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

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

Under the action 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 action of luteinizing hormone (LH), it is possible to mature the egg itself within it in a fairly short time.

After release, the egg slowly moves along the tube towards the uterine cavity. If fertilization occurs, then the embryo is already lowered into the uterus, and if conception has not happened, then the egg also descends into the uterus and dies there within 24 hours.

As a result of hormonal disruption, ovarian dysfunction and for a number of other reasons, the cycle provided by nature may be disrupted, and therefore a woman may 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 become pregnant naturally.

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

Stimulation of ovulation gives a real chance of 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 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... Medical artificial stimulation of ovulation is usually not performed for women over 40.

With complaints about the impossibility of getting 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 have a regular sex life. If the spouses (especially the woman) are already 35 years old or more, then the waiting period for conception naturally decreases to six months.

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

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 work of the multifollicular ovaries, there are also stimulation schemes for endometriosis.

In case of hormonal disruptions, when ovulation is often "late", it stimulates late ovulation.

Also the procedure is indicated for women with significant metabolic disorders, which is manifested by obesity or, conversely, underweight, because under these conditions, the couple often cannot get pregnant on their own.

Artificial stimulation methods

There are many methods by which you can support ovarian function and help ovulation.

In addition to medications, 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, complement complex treatment well and contribute to the healing of the whole body in general and the reproductive system in particular.

Despite the huge number of recommendations and ways to achieve the desired, the main method with proven effectiveness, in which the effect is less attributable to the usual lucky coincidence of circumstances, is hormonal drug stimulation.

How is drug stimulation, preparation

After a woman turns to a doctor, she and her partner are recommended to undergo a detailed examination designed 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 infections.

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

Woman an ultrasound scan of the pelvic organs and mammary glands is mandatory... Sometimes laparoscopic diagnostics may be required to make sure the fallopian tubes are patent.

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

If you suspect a pathology inside the uterus, 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, already at this stage, a woman manages to become pregnant., since the pathologies that caused her ovulatory cycle disruptions, in most cases, can be treated.

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

The third stage is the stimulation itself. The ovulation induction protocol regimens vary. 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 it’s not the turn of the hormones. Pregnancy occurs before the third stage in the event that a woman manages to completely reconsider her attitude towards unsuccessful attempts to get pregnant. Fear, anxiety, worries, grief, disappointment at the psycho-physical level trigger a blockage 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 drugs 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 drugs of female sex hormones is carried out - "Proginova", the external drug "Divigel" and other drugs are used, which contain the hormones estrogen and progesterone.

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

Activities should be started immediately after your period ends.

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

Even in preparation a woman must donate blood for hormonal analysis in order to identify 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 response of the ovaries 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 again visit a doctor who can make adjustments to the treatment regimen.

In total, 5-6 cycles with stimulation are considered acceptable.. If they did not bring a result, 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 fertilization "in vitro", fertilization of the 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 depletion of the ovaries, their premature aging.

To stimulate ovulation, you do not need to go to a gynecological hospital. A woman can be at home, in her usual conditions. She must adhere to the prescribed schedule of visits to the doctor for ultrasound control, as well as take all prescribed drugs in full accordance with the specified individual dosage.

Preparations - list

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

follicle growth stimulants;
triggers of ovulation.

The first ones are prescribed from the 5th day of the cycle (immediately after menstruation), and the triggers are introduced once - when the ultrasound shows the follicle's complete readiness to release an egg. They mimic the release of luteinizing hormone, under the action 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 luteum.so that pregnancy, if it occurs, could develop normally. Let's look at the drugs of all these groups in more detail.

"Clostilbegit (" 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 medicine is a stimulant for the formation and growth of follicles in the ovaries.

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

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

If a woman's menstruation occurs quite regularly, there are no long-term interruptions, 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 to be expected from 11 to 15 days of the cycle.

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

If both schemes do not show a result, the treatment is interrupted for three months, after which the course can 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 the assisted reproductive plan are chosen.

Side effects of the drug can give a woman unpleasant sensations... These are nausea, vomiting, flatulence, headache, increased drowsiness, inhibition of movements and mental reactions, therefore, during treatment, a woman is advised to give up driving and work associated with high risks to life.

Many women while taking "Clomid" notice that they are overcome by a depressed mood, their sleep and appetite are disturbed. Pain in the lower abdomen, minor pain in the chest area, white fluid discharge from the genitals may appear.

"Clostilbegit", like other drugs that stimulate follicular growth, increase the risk of subsequent multiple pregnancy. Many women note that during treatment, they become somewhat fat.

The analogues of this remedy are "Clomiphene", "Serofen", "Serpafar".

"Letrozole"

This non-steroidal drug also enhances the production of FSH and promotes the onset of ovulation, however, experts consider it more effective than Clomiphene, although Clomiphene remains the first choice.

Letrozole has significantly fewer side effects, making it more pleasant to take. In addition to regulating hormones, the drug improves the condition of the endometrium. There are also several schemes by which this drug 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 the 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 injections, and then an injection of hCG is given at a dosage of 10,000 U, as soon as the dominant follicle reaches the desired size by ultrasound (from 18 mm).

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

"Gonal-F"

This drug also belongs to the group of drugs, stimulating 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 ovarian cells of female Chinese hamsters.

The drug is injected subcutaneously, it is sold in special, easy-to-use syringe pens. "Gonal-F" is prescribed in the event that stimulation with the first drug in the order of prescription - "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 note diarrhea, temporary blurred vision, acne, weight gain.

The agent is administered subcutaneously. The first injection will be given by the doctor, 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, the woman needs to choose a new injection site, it is not necessary to inject into one area.

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

Puregon

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

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

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

The dose depends on how the patient's ovaries "respond" to the effect... Daily monitoring of ultrasound and determination of estrogen in the blood will help the doctor to have a good idea of what exactly is happening in the gonads of a woman, 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 a 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 follicular growth and an increase in the concentration of estadiol in the blood). The stimulation ends with an injection of hCG in a dose suitable for the induction of ovulation (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 during the initial period of bearing a baby - most intensively up to 12 weeks. An injection of this agent in a dosage of 5,000 to 10,000 IU is used in order for the very fact of ovulation to occur, so that the ovum can leave the follicle stimulated in the first stage.

Then the drug can be injected every two days before the date of the expected period in order to maintain the functions of the corpus luteum, producing sex hormones necessary to maintain pregnancy.

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

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

Side effects of the drug include irritability and mood swings, headaches, and 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 ("Duphaston")

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, since it helps to maintain pregnancy, promotes correct implantation, regulates many processes, adjusting the woman's body to a new state for her.

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

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

From "Duphaston" women do not gain weight, 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 selected for stimulation, as well as throughout the entire time while stimulation is taking place, and then until pregnancy is confirmed.

Sometimes, in order to establish regular ovulation, it is enough to adjust the woman's lifestyle, her diet and prescribe her vitaminstherefore, vitamin support at the planning stage of pregnancy 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 participate in the process of producing sex hormones in a woman.
Vitamin A free follicle development is not avoided, 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, promotes its exit from 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.

To stimulate ovulation, vitamins are recommended to be taken as follows:

From the beginning of menstruation to ovulation - vitamin E, vitamin A and folic acid.
From the moment of ovulation throughout the entire 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 drugs.

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

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

From 15 to 24 days of the cycle - Riboxin, pyridoxine, folic acid and potassium oratate 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 the theory of probability plays an important role in alternative medicine - there is always a chance to conceive, and therefore drinking weed, in principle, does not hurt.

Modern doctors respect folk remedies for improving women's health, but warn against self-prescription.

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

There are also certain rules for folk ways to increase ovulatory ability. For instance, it is not worth taking herbs at the same time as hormonal 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 with hormonal medications.

The principle of treatment in alternative medicine is exactly the same as in traditional medicine. In the first half of the cycle, take herbal remedies that help the growth and development of the follicle... These are 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 borax uterus - This plant contains plant progesterone. Decoctions and infusions are made from it, according to the instructions for use, which are enclosed in pharmacy packaging with this herbal collection.

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

Effectiveness

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

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%. It is this number of couples who manage to eventually help get pregnant naturally.

The rest are helped by IVF, ICSI and other assisted reproductive techniques and techniques.

Potential consequences and complications

Stimulation is carried out with hormonal drugs, it would be wrong to underestimate the effect of which on the female body. Induction itself during the cycle often causes painful and unpleasant sensations in women. Many complain that the lower abdomen is pulling and even that the ovaries hurt after stimulation. Almost everyone notes "hot flashes" - hot flashes that occur in waves.

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

If the signs of such a pathology appear at a later date - after 7-10 days of the menstrual cycle, then the syndrome is quite difficult, 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 processesoccurring in a woman's body under the influence of hormones, and make correct and informed decisions.

Reviews

Reviews of those who became pregnant after ovulation stimulation mainly relate to such a problem as controlling the growth of follicles.

Despite the fact that the guidelines state that ovulation and follicle size should be monitored using ultrasound every day or every other day, many doctors limit themselves to only the recommendation to “seize the right moment” using pharmacy ovulation tests. As a result, many women miss the moment, and the stimulation course has to start over.