Stimulation of ovulation is considered the most common and popular way to achieve a long-awaited pregnancy. But it has its pros and cons.
About how artificial stimulation of natural for a woman processes, what preparations are used and what results can be achieved, we will tell in this material.
What is ovulation?
Each or almost every month in the body of a healthy woman, capable of conceiving, ovulation occurs. After menstruation for the first half of the cycle, which lasts approximately 14 days, follicles are ripening in the ovaries. One of them, dominant, bursts in the middle of the cycle and releases an egg ready for fertilization.
Ovulation and subsequent menstruation usually divides 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 day 16, with a cycle of 32 days, ovulation usually occurs on day 18.
But this is ideal, but in practice small deviations from the rules are permissible.
The release of the egg takes place for 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 the period of ovulation, because the process of egg release is regulated by the pituitary gland, which begins to produce luteinizing and follicle-stimulating hormones.
Under the action of FSH (a hormone stimulating the growth of follicles) in the first half of the cycle there is an increase in the follicle, under the action of the lyutenizing hormone (LH) in a fairly short time, it is possible to ripen the ovule itself inside it.
After the release, the egg slowly moves along the tube towards the uterine cavity. If fertilization occurs, then the embryo already falls into the uterus, and if the conception does not come about, the egg also descends into the uterus and dies there within 24 hours.
As a result of hormonal failure, dysfunction of the ovaries and for a number of other reasons, the cycle envisaged by nature can be violated, in connection with which a woman can have anovulatory cycles, that is cycles without ovulation.
It can be cycles, when the egg does not ripen, or ripens, but does not come out of the follicle. In this case, it is impossible for a woman to become pregnant naturally.
To help doctors come, who can stimulate the ovaries for pregnancy planning. Most often this is done with hormonal therapy.
Stimulation of ovulation gives a real chance for conception to couples who have not been able to get pregnant for a long time. The procedure belongs to the category of assisted reproductive technologies.
Indications for stimulation – for whom is it conducted?
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 different manifestations of their dysfunction, including age. Medical artificial stimulation of ovulation is usually not performed in women after 40 years.
With complaints about the inability to become 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 monitoring of the maturation of the follicle using ultrasound diagnostics.
If this examination shows that ovulation does not occur, preparation for stimulation begins.
The main indication for the drug stimulation of the ovaries is the absence of pregnancy during the year, provided that the spouses are not protected and live a regular sex life. If the couple (especially a woman) for 35 years or more, the period of expectation of conception naturally decreases to six months.
The procedure is contraindicated for 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 on the background of hypotholeamic-pituitary insufficiency.
The reason for the procedure may be preparation for IVF or intrauterine artificial insemination – insemination. Doctors usually quite successfully manage to stimulate the work of multifollicular ovaries, there are also incentive schemes for endometriosis.
With hormonal failures, 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 with these conditions it is often impossible to get pregnant with the couple alone.
Methods of Artificial Stimulation
There are a lot of methods with which you can support the function of the ovaries and help to achieve the ovulation.
In addition to drugs, pills and injections in hormonal therapy, which is used to restore the ovaries and provoke the release of the egg from the ripe follicle, the folk remedies that women practice at home are widespread. These are herbs, mud therapy, vitamin therapy and some physiotherapy procedures, for example, acupuncture.
Some even practice yoga for conception. Some asanas (postures), according to the women, supplement the complex treatment well and contribute to the improvement of the whole organism and the reproductive system in particular.
Despite a myriad of recommendations and ways to achieve the desired, the main method with proven efficacy, in which the effect is less likely to be due to the usual successful combination of circumstances, is drug-induced hormonal stimulation.
How does the Medication stimulate Ovulation? Special Preparations
After the treatment of the woman to the doctor, it is recommended that she and her partner undergo a detailed examination to determine the true cause of family infertility. A woman is assigned the whole complex of laboratory tests from general and detailed blood and urine tests to blood tests for infections, including those transmitted through sexual intercourse.
Be sure to do a blood test for hormones (luteinizing, follicle-stimulating, progesterone, prolactin and a number of others, if the doctor deems it necessary).
Women are required to have ultrasound of the pelvic organs and mammary glands. Sometimes laparoscopic diagnosis may be required to ensure that the fallopian tubes are passable.
Sexual partners of women losing blood tests for infectious diseases, genital infections, as well as passes semen analysis to determine the quality of its germ cells, as in male infertility without exception schemes stimulate ovulation will not give any result.
If there is a suspicion of pathology inside the uterus, hysteroscopy is performed.
As soon as the first stage, diagnostic, is left behind, the second stage begins – treatment of existing inflammatory diseases and hormonal imbalance. Sometimes already at this stage the woman manages to become pregnant, because the pathologies that caused her ovulatory cycle failures, in most cases, can be treated.
Women with excess weight or a deficit (weight less than 45 kilograms), a course of body mass correction is prescribed. According to experts, the patient sometimes only needs to reduce her weight by only 10% so that ovulation begins to occur on her own.
The third stage is stimulation itself. The protocols for stimulating ovulation can be different. The doctor determines the specific drug, its dosage, duration and frequency of reception on an individual basis, taking into account the age, weight and gynecological history of the patient.
Sometimes the hormones do not turn up. Pregnancy comes to the third stage in the event that the woman manages to completely reconsider the attitude to unsuccessful attempts to become pregnant. Fear, anxiety, distress, frustration, frustration at the psycho-physical level trigger the blockage of estrogen production, so ovulation does not occur.
If a woman learns to correctly treat failures, perceive them as temporary and extremely harmful to her health, the ovulatory cycle is often restored without medication at all.
At the initial stage, doctors are trying to prepare the endometrium of the uterus. With a thin endometrium, conception, even if it does occur, can not lead to pregnancy, because the embryo will be difficult to gain a foothold in the uterine cavity. To prepare for a course of treatment with drugs of female sex hormones – used Proginova (Estradiol valerate), an external preparation Divigel (estradiol gel) and other drugs that have in their composition hormones estrogen and progesterone.
As a rule, from the 5th day of the cycle, special preparations are prescribed, while the doctors monitor the maturation of the follicle by ultrasound.
To the measures should start immediately after the end of menstruation.
It is not excluded that the woman will have to visit the ultrasound diagnosis room from the 10th day of the menstrual cycle daily. As soon as one of the follicles reaches a size of 17-18 mm, one can perform stimulation and wait 24-36 hours for the onset of the coveted moment – the very ovulation.
Even in the course of preparation, the woman necessarily donates blood for hormonal analysis in order to reveal the level of AMH – anti-mullerian hormone (AMH), which is “produced” by the growing structures of the follicles.
If the woman’s own level of AMH 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 the examination in dynamics will also allow doctors to see the effectiveness of stimulation and prevent excessive hyper stimulation.
Stimulate the ovaries can be 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 the doctor who can make adjustments to the treatment regimen.
In total, 5-6 cycles with stimulation are considered acceptable. If they did not work, the method is considered ineffective for this couple, they are recommended other assisted reproductive techniques, including surrogate motherhood, the removal of ripened healthy ovaries from the ovaries with the subsequent fertilization “in vitro”, fertilization with the sperm of the donor egg husband, etc. Everything depends from the true causes of infertility and whether the woman develops her own healthy sex cells.
To insist on the continuation of stimulation of ovulation is not necessary, after 5-6 courses there is a high probability of irreversible depletion of the ovaries, premature aging.
To stimulate ovulation, do not go to a gynecological hospital. A woman can stay at home, in the usual conditions for her. She must steadfastly adhere to the scheduled schedule for a doctor’s visit to monitor ultrasound, and also take all prescribed medications in full accordance with the specified individual dosage.
Preparations for Stimulation of Ovulation – the List
All drugs that are included in the schemes of ovulation stimulation protocols are divided into two large groups:
- stimulators of follicle growth;
- triggers of ovulation.
The first drugs are prescribed from the 5th day of the cycle (immediately after the menstrual period), and the triggers are administered one-time – when the ultrasound shows the full readiness of the follicle to release the egg. They mimic the release of the lyutenizing hormone, under which the egg quickly ripens and leaves the follicle.
After ovulation has taken place, drugs are prescribed that help the ovaries support the function of the yellow body, so that the pregnancy, if it occurs, could develop normally. Let’s consider the preparations of all these groups in more detail.
“Clomiphene Citrate”, “Clomid”
Clomid is widely known to women planning a pregnancy, as it has well proven itself as a remedy of stimulating the ovulatory process. The drug is a stimulator of the formation and growth of follicles in the ovaries.
In certain doses helps the development of follicle-stimulating hormone FSH, luteinizing hormone (LH) and gonadotropins. The product is available in the form of tablets.
There are no general recommendations on the dosage regimen, because the dose depends on how the ovaries respond to the medication – it can be reduced or increased at the discretion of the treating physician.
If a woman’s menstruation occurs regularly enough, there are no long-term disruptions, then Clomid treatment begins on the 5th day of the cycle (counted from the first day of menstruation). According to one of the most common schemes, the drug is taken every day for five days, in which case it is expected that ovulation is expected from 11 to 15 days of the cycle.
If there is no ovulation, then in the next cycle, another scheme is introduced, at which the drug should be taken from the 5th day of the cycle for 5 days, but in a doubled dosage.
If both schemes fail to show results, 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 he did not bring the long-awaited result, treatment “Clomid” is recognized as completely ineffective and choose other methods of an auxiliary reproductive plan.
Side effects of the drug can give a woman unpleasant sensations. This is nausea, vomiting, flatulence, headache, increased drowsiness, inhibition of movement and mental reactions, so for the period of treatment, it is recommended that women give up driving and work associated with high risks to life.
Many women during the reception of “Clomid” notice that they are overcome by depressive mood, they are disturbed by sleep, appetite. There may be pain in the lower abdomen, minor pain in the chest, white liquid discharge from the genitals.
“Clomid”, as well as other drugs that stimulate follicular growth, increase the risk of subsequent onset of multiple pregnancies. Many women note that, on the background of treatment, they are somewhat fuller.
The analogues of this remedy are Clomifen, Clomiphene, Serophene, Serpafar.
This non-steroid drug also enhances the production of FSH and promotes the onset of ovulation, but experts consider it more effective than Clomiphene, although Clomiphene remains the first choice.
Letrozole (Femara) has significantly fewer side effects, so it is more pleasant to take it. In addition to the regulation of hormones, the drug improves the condition of the endometrium. There are also several schemes on 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, while in the second scheme, it is recommended that the woman drink the drug on the fifth day of the cycle at a dose of 5 mg.
The best results are indicated by the use of this drug as part of complex therapy: on the second to sixth day of the cycle, Letrozole is administered at a dosage of 2.5 or 5 mg per day, then on the 7th to 10th day of the cycle, a woman is injected with FSH in injections and then injected with hCG in a dosage of 10,000 units, once the dominant follicle has reached the desired size by ultrasound (from 18 mm).
Analogs of the drug – “Letrosan”, “Femara”.
Gonal-F (Follitropin Alfa)
This drug also belongs to the group that stimulates the growth and development of follicles in the ovaries in the first half of the menstrual cycle. In its composition – a recombinant hormone, which thanks to the efforts of genetic engineers received from ovarian cells female Chinese hamsters.
The drug is administered subcutaneously, it is sold in special convenient for use syringes-pens. “Gonal-F” is prescribed in the event that stimulation is the first in the order of the drug – “Clostilbegyt” is ineffective.
Similar actions of this drug are typical for many hormonal agents – headaches, dizziness, drowsiness and lethargy, lack of tonus, dryness in the vagina, changes in appetite, insomnia. Sometimes women notice diarrhea, temporary impairment of vision, the appearance of acne, weight gain.
The agent is administered subcutaneously. The first injection will be done by a doctor, and the subsequent woman will be able to stab herself at home.
The stimulation course starts 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 introduction, the woman needs to choose a new site for the injection, do not inject into one zone.
Analogs of the drug are “Choragon”, “Ovitrelle”.
Puregon (Follitropin Beta)
Puregon can also be used for the initial preparation of follicles in the first half of the cycle. It is available in the form of powder for the preparation of solution for injection, in the form of ready-to-use solution and solution in cartridges. The liquid is administered intramuscularly and subcutaneously. The drug in the “pen” is administered only one way – subcutaneously.
The composition of the drug Puregon – recombinant FSH of the same Chinese hamster, which in many ways benefits from FSH, obtained from human urine. It is more safe, easier to tolerate.
Under its influence in the ovaries, women begin to actively grow several follicles, which can then be used in any of the assisted reproductive methods.
The dose of Puregon depends on how the patient’s ovaries respond to the effect. Daily monitoring of ultrasound and the determination of estrogen in the blood will help the doctor to well imagine what exactly is happening in the sex glands of a woman, and not 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. Begin treatment from the second day of the menstrual cycle, it lasts about 7-14 days (all depends on when it will be possible to achieve growth of the follicles and increase in the concentration of estadiol in the blood). Complete the stimulation of a hCG prick at a dose suitable for the induction of ovulation (usually 10,000 IU).
Human Chorionic Gonadotropin (hCG)
Human Chorionic Gonadotropin is obtained from the urine of pregnant women, because this hormone is produced in large quantities in the initial period of bearing the baby – most intensively up to 12 weeks. The injection of this agent in a dosage of 5000 to 10,000 IU is used to cause the very fact of ovulation, so that the egg can leave the stimulated follicle in the first stage.
The drug can then be injected every two days, up to the expected monthly date, in order to maintain the function of the yellow body producing the sex hormones needed to maintain the pregnancy.
If the pregnancy is confirmed, hCG can subsequently also be used up to 10-11 weeks, if there is a threat of miscarriage due to low self-level of hCG.
If a woman on ultrasound reveals a threat or the fact of ovarian hyperstimulation, then the use of hCG is abstained. It is also not recommended to use chorionic gonadotropin in women with kidney and liver pathologies.
Among the side effects of the Human Chorionic Gonadotropin – irritability and mood swings, headaches, drowsiness. HCG also increases the chance of conception of twins or triplets, and this fact cannot be ignored in planning pregnancy.
The analog of the preparation is “Pregnyl”.
It is a popular hormonal drug whose main active ingredient is an analog of progesterone. The remedy can be irreplaceable in the second half of the menstrual cycle, because it helps to maintain pregnancy, promotes proper implantation, regulates many processes, adjusting the woman’s body to a new condition for her.
For ovulation, “Duphaston” has no effect, but after it is become very important, as 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.
Dosage is assigned individually depending on the result of the blood test for progesterone, and also the purpose of the reception – tablets 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 occurred.
With “Duphaston” women do not get fat, do not lose concentration of attention, and therefore can continue to operate the car without restrictions while taking this medicine.
Vitamins for Stimulation of Ovulation
Vitamin preparations are included in the standard treatment regimens for female and male infertility. When stimulating ovulation, the intake of vitamins is shown 1-2 months before the cycle chosen for stimulation, as well as throughout the time that stimulation takes place, and then until pregnancy is confirmed.
Sometimes in order to establish regular ovulation, it is enough to adjust the lifestyle of a woman, her nutrition and prescribe her vitamins, so vitamin support at the planning stage of pregnancy is of great importance.
Especially important for the normalization of ovulatory cycles vitamins D, A, B12, B 9, E, C:
- Vitamins D and D 3 are involved in the process of producing sex hormones in women.
- Without vitamin A, the development of the follicle does not go away, in addition, retinol is involved in the normalization of the composition of cervical mucus.
- Vitamin E is involved in cellular processes, helps the maturation of the egg, contributes to its release beyond the follicle.
- Ascorbic acid (vitamin C) improves blood circulation, which helps enrich the ovaries with useful substances.
- B group vitamins, especially folic acid, regulate the duration of the luteal phase of the cycle, and also increase the vitality of the oocyte.
To stimulate ovulation, it is recommended to take vitamins as follows:
- 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 the biochemical blood test, which shows which substances are necessary, and which without synthetic drugs is sufficient.
An example of a successful scheme of vitamin therapy can be as follows:
- From 1 to 14 day of the cycle – cocarboxylase + riboflavin (in injections) every day, as well as lipoic acid and vitamin E in tablets and capsules.
- From 15 to 24 day of the cycle – riboxin, pyridoxine, folic acid and potassium orate in tablets, as well as vitamin E three times a day.
Stimulation of Ovulation with Folk Remedies
Some of our ancestors knew about women’s health long before such concepts as “stimulation of ovulation” appeared. However, specialists are inclined to think that in probability theory plays an important role in the theory of probability – there is always a chance to conceive, and therefore it will not hurt to drink grass in principle.
Modern doctors respect the folk remedies for improving women’s health, but they warn against their self-destiny.
Any folk treatment should be discussed with the attending physician in order not to harm.
For folk ways to increase the ovulatory capacity, there are also certain rules. For example, it is not necessary to take herbs simultaneously with hormone therapy with medications, this can lead to ovarian hyperstimulation.
Herbs and roots for female fertility are not taken in the period of menstruation, and treated for more than 3 consecutive months, as well as hormonal medications, is not recommended.
The principle of treatment in non-traditional medicine is exactly the same as in traditional medicine. In the first half of the cycle, plant remedies are used that help the growth and development of the follicle. This sage – broths and essential oil, decoction from the petals of roses, infusion of the seeds of plantain.
In the second half of the menstrual cycle, after ovulation, folk healers recommend taking the bovine uterus – this plant contains plant progesterone. From her make decoctions and infusions, according to the instructions for use, which is enclosed in pharmacy packaging with this herbal collection.
To achieve ovulation, a woman is advised not to take alcohol, not to abuse nicotine, to diversify her diet with products that best affect the work of the ovaries. This liver, low-fat red meat, sea fish, dairy products.
Efficiency of Stimulation Methods
In the first cycle, when stimulating ovulation, a woman can conceive 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-induced induction of ovulation is estimated at 70-80%. It is this number of couples that can ultimately help to get pregnant naturally.
Others come to the aid of IVF, ICSI and other auxiliary reproductive techniques and techniques.
Possible Consequences and Complications
Stimulation is carried out by hormonal drugs, to underestimate the impact of which on the female body would be wrong. The very induction during the cycle often causes painful and unpleasant sensations in women. Many complain that pulls the lower abdomen and even that the ovaries ache after stimulation. Almost all celebrate “hot flashes” – heat attacks, which occur undulating.
One of the most dangerous consequences of stimulation is super stimulation, in which the growth of follicles occurs so rapidly that the hyper stimulation syndrome develops. He most often can give information about himself for the first time on day 3-4 after the onset of induction.
If the signs of such pathology appear later in life – after 7-10 days of the menstrual cycle, the syndrome proceeds quite hard, with vomiting, diarrhea, edema of the limbs and face, a drop in the blood pressure level, a sharp deterioration in well-being.
A woman may need qualified help in a hospital. Therefore, a doctor with a large experience in reproductive programs should be able to stimulate, which can control the processes taking place in the body of a woman under the influence of hormones in a timely manner and make correct and balanced decisions.
Reviews of those who become pregnant after stimulating ovulation, mainly concern such problems as the control of the growth of follicles.
Despite the fact that the methodological recommendations say that ovulation and the size of the follicles should be monitored with the use of ultrasound every day or every other day, many doctors are limited only to the recommendation “to catch the right moment” with the help of pharmacy tests for ovulation. As a result, in many women the necessary moment is missed, and the stimulation rate must be started again.
Many women report marked side effects, unpleasant symptoms that accompanied them throughout the treatment.