Fertility drugs – stimulation and regulation of ovulation

What is ovulation stimulation?

Ovulation stimulation is prescribed to women diagnosed with infertility. The reason for the procedure is the absence of your own ovulation. To determine whether the female organs are functioning properly, folliculometry is performed. It is a process of monitoring the follicles and endometrium over several cycles (at least 3).

Ultrasound for ovulation. Detailed article in understandable language.

How is ovulation stimulated for conception? A woman needs to visit the ultrasound room several times per cycle. The first visit occurs on days 10-12 of the cycle. The second visit is carried out on days 14-15. The last time you need to undergo an ultrasound is 1-3 days after the day of expected ovulation. In women with a standard cycle, this occurs on days 16-17. The diagnosis is made based on the data obtained at the last visit. If the corpus luteum and fluid behind the uterus are absent, this may indicate a lack of ovulation. To obtain a reliable result, the study must be carried out over several cycles.

The most common cause of anovulatory cycles is hormonal imbalance.

Therefore, for the procedure, agents are used that influence the production of sex hormones. During treatment, a woman's chances of successfully conceiving increase.

Recovery rules

1. Before starting stimulation, you must have the results of your husband’s spermogram (IVF/ICSI) in hand.
   They should be pretty good or at least suitable for natural conception. A man should undergo these tests as soon as possible. The spouse must take tests regardless of the results that were in the past year, and also regardless of the factor of the presence (of) children. If your doctor orders your sexual partner to have a spermogram analyzed only after several courses of stimulation have been completed to no avail, change your doctor. This approach indicates his incompetence in solving this problem.
2. Before performing ovulation restoration, it is also necessary to undergo a test for patency of the fallopian tubes (HSG) or laparoscopy (the exception is 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 reaction to the stimulation process and the development of follicles.

How is ovulation stimulated?

And so, after visiting a doctor and undergoing a detailed examination designed to establish the true cause of family infertility, a woman is prescribed a full range of laboratory tests, from general and detailed blood and urine tests to blood tests for infections, including sexually transmitted ones.

A man also undergoes blood tests for sexually transmitted infections, and also undergoes a spermogram, because if the quality of sperm is poor, then in case of male infertility, all ovulation stimulation schemes without exception will not give any result.

Next, if any diseases are identified, existing inflammatory diseases and hormonal imbalances are treated. Already at this stage, it is possible to induce ovulation in a natural way, since the pathologies that caused the ovulatory cycle to fail can, in most cases, be treated.

Women who have problems with being overweight or underweight are prescribed a course of weight correction.

Indications for stimulation

Desire alone is not enough to carry out stimulation. A doctor's consultation is required. Treatment is prescribed only if there are compelling reasons. Indications for ovulation stimulation are as follows:

• Absence of pregnancy for more than a year;
• Menstrual irregularities;
• Polycystic ovary syndrome;
• Multifollicular ovaries.

Before medical manipulations, it is mandatory to check the fallopian tubes and analyze the quality of the man’s seminal fluid. If infertility has male or tubal factor, stimulation will not be appropriate.

Combined oral contraceptives

Combined oral contraceptives (COCs) are also used to stimulate ovulation. But it is not their direct action that contributes to this. On the contrary, COCs suppress their own ovulation. Only the withdrawal of this group of drugs can cause the release of one’s own hormones - the withdrawal phenomenon, which leads to rapid growth and maturation of follicles.

Taking contraceptives before stimulating ovulation for assisted reproductive technologies allows you to achieve “comfortable” conditions:

• it becomes possible to plan cycles;
• withdrawal effect;
• prevention of cysts during stimulation is carried out;
• pregnancy is excluded at the time of stimulation.

All information provided in this article is for informational purposes only. Before using medications, consult a doctor. Self-medication can harm much more than the disease itself.

Ovulation stimulation scheme

If after all these steps ovulation does not occur, the doctor will prescribe a specific drug, dosage, duration and frequency of administration.

How is ovulation stimulation done to get pregnant? At the initial stage of the procedure, doctors try to prepare the endometrium of the uterus. With a thin endometrium, conception may not lead to pregnancy, because it will be difficult for the embryo to gain a foothold in the uterine cavity. To prepare, a course of treatment with female sex hormones is carried out - Proginova, Divigel and other drugs are used (containing the hormones estrogen and progesterone).

Already from the 5th day of the cycle, special medications are prescribed, as well as tracking the maturation of the follicle using ultrasound. When one of the follicles reaches the desired size (17-18 mm), stimulation can be carried out and ovulation can be expected after 24 (sometimes up to 36) hours.

During the procedures, the level of AMH in the body is monitored. If a woman's own AMH level is low, the effectiveness of the protocol will be significantly reduced. The level of this hormone when examined over time will also allow doctors to see the result of stimulation and prevent hyperstimulation.

Hyperstimulation - description

Read more about anti-Mullerian hormone (AMH).

Stimulation can be carried out up to three times in a row, that is, within three cycles. If conception does not occur during this time, a break is required so that the ovaries can rest and recover.

The success of the measures taken is indicated by the formation of the corpus luteum at the site of the ovulated follicle. To increase the chances of successful implantation of the embryo, the hormone progesterone is needed. To ensure its entry into the body, take Duphaston (dydrogesterone) or Utrozhestan. Progesterone drugs are taken until the arrival of menstruation. Before canceling them, you need to make sure there is no pregnancy.

Application of Clostilbegit (Clomiphene)

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

Be aware of the side effects of this drug. An important side effect is its antiestrogenic effect. It is this fact that can harm pregnancy. Estrogens occupy an important place in the overall process of conception. Among their actions are noted:

1. Stimulates the secretion of cervical mucus. It is a favorable environment in which the life, movement and nutrition of sperm are carried out;
2. Stimulation of the release of luteinizing hormone;
3. Promoting endometrial regeneration and growth.

If estrogen deficiency occurs, ovulation becomes impossible, which means pregnancy will not occur.

Less dangerous side effects include:

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

The list is quite large. The harm outweighs the potential benefit of the medication. There is also a very high risk during fetal development. The use of this drug does not promote pregnancy in all cases: 2635 cases of pregnancy out of 7578 patients who used it. Child survival rate is 98.16% for the birth of one child, and 83.25% for the birth of twins. (Data from Drugs.com).

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 treatment methods, having previously undergone an additional examination of the body.

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

Drugs to stimulate ovulation

Stimulation of ovarian ovulation with drugs is carried out after eliminating contraindications. The procedure is considered risky, so it is important to familiarize yourself with possible complications before undergoing it. Throughout the entire cycle, a woman needs to take medications. The response of the ovaries to the therapy is monitored by ultrasound. Drugs that stimulate follicle growth include:

• Clostilbegit (clomiphene citrate)
• Letrozole Femara
• Menopur

An injection to stimulate ovulation.
Drugs to stimulate ovulation also include Divigel and Proginova. They influence the enlargement of the endometrium. The quality of implantation depends on the thickness and looseness of the uterine layers. There is an opinion that Proginova and ovulation are mutually exclusive concepts. But estradiol, which is part of the tablets, does not have a suppressive effect on the endometrium. Divigel has a similar effect. It is distinguished by its transdermal method of application.

Gonal containing hCG

Stimulation with Gonal or any other drug containing hCG is carried out after the dominant follicle reaches a size of 18 mm. The injection is administered once in a dosage of 5,000 to 10,000 units. The injection causes the follicle to rupture. Thanks to this, the egg is released and directed towards the uterus. This occurs within 24-48 hours after the injection. It is during this period that a woman’s fertility increases.

Read more about HCG here

Stimulation of ovulation with clostilbegit

The drug is a non-steroidal anti-estrogenic drug. In moderate doses, it is able to stimulate the body's production of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin. Stimulation with clostilbegit is carried out for women preparing for IVF or intrauterine insemination.

Sold in pharmacies only with a doctor's prescription! Self-medication with Clostilbegit is NOT recommended!

General indications of the drug:

• Anovulation (Lack of ovulation);
• Amenorrhea (Dysgonadotropic form);
• Androgen deficiency;
• Secondary amenorrhea;
• Galactorrhea;
• Oligomenorrhea;
• Stein-Leventhal syndrome;
• Chiari-Frommel syndrome (Prolonged postpartum amenorrhea-galactorrhea syndrome);
• For men: Oligospermia.

Amenorrhea - description

Oligomenorrhea - description

Galactorrhea - description

Stein-Leventhal syndrome - description
Stimulation with clostilbegit is contraindicated in women with fallopian tube obstruction. Pregnancy in this case may occur, but it will turn out to be ectopic and cause serious complications for the health and morale of the woman dreaming of a child. Stimulation is also not done for inflammatory diseases of the pelvic organs.

Initially, during diagnosis, these ailments are identified and attempts are made to treat them.

Treatment regimens and dosages of the drug are individual for each patient. Only a doctor can choose from. DO NOT self-medicate!

Letrozole to stimulate ovulation

Since 2001, it has been prescribed to combat infertility in women. The main component of the drug is an aromatase inhibitor. The medicine has a slight antiestrogenic effect. The advantage of the product is the short period of elimination from the body. Its components are not present in the body at the time of implantation of the fertilized egg. In addition, the product has a beneficial effect on the endometrium of the uterus, preparing it for the attachment of the embryo.

Aromatase - description

Among the disadvantages of the stimulant, the risks of developing complications after taking it are possible:

• Nausea;
• Abnormal bowel movements (diarrhea or constipation);
• Abdominal pain;
• Feeling of dry mouth;
• Leukopenia;
• Headache;
• Feeling of anxiety;
• Increased fatigue;
• Sudden change of mood;
• Depression;
• Drowsiness;
• Memory impairment;
• Tachycardia, increased heart rate.
• During treatment, it is possible to increase blood pressure and develop thrombophlebitis with damage to the deep veins;
• Development of heart failure;
• Allergic rashes (Erythema, Papules, Vesicles);
• Loss of scalp hair;
• Increased sweating;
• Swelling of the respiratory system;
• Pain and aching in bones;
• Development of osteoporosis and arthrosis;
• Problems in the genitourinary system (frequent urination after taking it, the sensitivity of the organs of the urinary system to the introduction of pathogenic flora also increases);
• Violation of the vaginal microflora (vaginal dryness, uterine bleeding)
• Unpleasant sensations in the chest.

To prescribe a drug, you need to undergo an examination and undergo tests as in the case of taking other drugs, namely:

• Analysis for sexually transmitted infections;
• Ultrasound of the reproductive system;
• Ultrasound of the mammary glands.

The doctor assesses the patency of the woman's fallopian tubes. In case of positive tests, the doctor individually prescribes letrozole to stimulate ovulation and a regimen.

The dosage is individual for each patient! DO NOT resort to self-medication, this can lead to irreparable consequences!

Stimulation of ovulation using folk remedies

Not all women know how to stimulate ovulation using folk remedies. The most effective are herbal infusions. They contain phytohormones. Therefore, before carrying out treatment, it is necessary to determine which hormones are missing in the body.

Hog queen

Borovaya uterus
Borovaya uterus is considered a natural source of progesterone. It is taken in the second half of the cycle, immediately after the release of the egg into the abdominal cavity. The boron uterus contains resins, tannins, organic acids and coumarins. To get the maximum benefit from the herbal decoction, drink it 1 tbsp. l. 4 times a day. Before the day of the expected menstruation, the intake is canceled.

Stimulating ovulation with sage

Stimulating ovulation with the help of sage is practiced if a woman does not want to resort to medication. Sage should be taken from day 5 of the natural cycle until ovulation occurs. It stimulates the activity of the ovaries and helps to enlarge the endometrium. A decoction of sage is indicated for use in cases of estrogen deficiency. Drink it three times a day, 1/3 cup.

Sage

Mud to stimulate ovulation

Mud therapy is an effective way to heal the body. It helps in cases where infertility is caused by polycystic disease, adhesions in the tubes or inflammation. Ovulation occurs as a result of eliminating the cause of the disorders. The mud is applied to the lower abdomen and left for 20 minutes. The course of treatment includes 21 procedures.

Read more about ovulation stimulation in polycystic disease.

Acupuncture to stimulate ovulation

Acupuncture is a treatment method that involves influencing acupuncture points. It is practiced not only to treat female diseases, but also to improve the health of the entire body. The procedure must be carried out by a specially trained person using sterile needles. The desired effect is achieved by releasing prostaglandins into the blood and stimulating the production of endorphins. These processes send signals to the hypothalamus, which stimulates the production of hormones.

Prostaglandins - description

Vitamins to stimulate ovulation

Disturbances in the reproductive system may be associated with vitamin deficiency. In this case, the best way to stimulate ovulation is to take vitamin complexes. Of particular benefit for the reproductive system are folic acid and vitamins E, C and A. To ensure proper functioning of the thyroid gland, it is necessary to take iodine.

To improve the functioning of the ovaries, you can use dietary supplements. These include the drug Ovariamin. Its effectiveness is due to its rich vitamin composition. An equally effective homeopathic remedy is Cyclodinone. It evens out the cycle and restores fertility.

Sensations during stimulation

Each woman's body reacts to stimulation differently. In the first days of therapeutic treatment, nagging pain in the ovaries may be observed. They occur due to enlargement of the follicles. After the injection of gonadotropins, the pain may intensify. There is also an increase in sexual desire, which is triggered by the release of hormones.

In some cases, chest pain occurs during therapy. Your mood may change dramatically. 3-4 days before the egg leaves the follicle, a clear discharge resembling egg white appears. They are considered a favorable environment for the advancement of sperm. On the day of the hCG injection, the discharge becomes thin and more abundant.

Excellent article with hCG tables for days after ovulation.

If hyperstimulation develops due to the use of medications or folk remedies, the woman’s condition may be critical. In this case, the abdominal pain becomes acute. Flatulence develops and performance decreases. In such situations, urgent hospitalization is required.

After ovulation stimulation, pregnancy did not occur

The frequency of pregnancy after stimulation of ovulation in one cycle is about 15% (Data not scientifically confirmed, approximate figure from practice). Pregnancy does not necessarily occur in the first cycle; it occurs after stimulation of ovulation in subsequent cycles. Do not be upset, because natural ovulation after stimulation is possible in subsequent cycles.

Doctors cannot prescribe stimulation for more than three cycles in a row. It must be taken into account that stimulation with various drugs is not recommended no more than six times in a lifetime. The drugs can cause hyperstimulation, which is dangerous by depleting the ovaries.

Hormone tests

You need to check your hormone levels 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. Test results are also influenced by factors such as stress, nutrition, etc.

Pay attention to the levels 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. Deviations from the norm of these hormones can prevent ovulation. It is quite possible that after stabilizing the level of these hormones, ovulation will recover on its own.