Month: January 2022

Clostilbegyt (clomiphene) is one of the classes of selective estrogen receptor modulators. The mechanism of action of Clostilbegyt is based on the selective effect on estrogen receptors of the hypothalamic-pituitary system, in connection with which the receptors are blocked for estrogens and the feedback mechanism increases the secretion of gonadotropins (follicle-stimulating and luteinizing hormones), which, acting on the follicles in the ovaries, causes stimulation of their function (ovulation stimulation). There are indications that the blockade of the estrogen receptors of the hypothalamus leads to increased production of gonadoliberins, thereby providing a higher level of regulation of the hypothalamic-pituitary-ovarian system.

Clostilbegyt has certain pharmacokinetic features: good absorption by oral administration, a long (up to 7 days) half-life due to active binding to plasma proteins.

Indications for the use of Clostilbegyt

The indication for the use of clostilbegyt is infertility associated with the absence of ovulation. Taking into account the long experience (several decades) of using this drug for the treatment of anovulation, the pros and cons of using this drug have been well studied, various ovulation stimulation schemes have been developed.

Pros and cons of the drug

The main advantages of using clostilbegyt to achieve pregnancy are:

• low cost;
• wide availability;
• oral route of administration;
• high efficacy (in the absence of clomiphene resistance);
• a small number of possible complications in the treatment of infertility (low frequency of multiple pregnancies, low frequency of ovarian hyperstimulation syndrome).

However, despite the obvious advantages, clostilbegyt has significant disadvantages that limit its use in the treatment of infertility. The main negative factors when using clostilbegyt are:

• antiestrogenic effect, which can lead to impaired endometrial function, impaired properties of cervical mucus and vaginal epithelium;
• in some patients, the hypoestrogenic condition can cause vasomotor reactions (hot flashes);
• the use of SMER increases the risk of thrombotic complications of any localization.

Returning to the mechanism of ovarian function stimulation when using clostilbegyt (stimulation of gonadotropin secretion against the background of blockade of estrogen receptors of the hypothalamic-pituitary system), it is important to understand that the use of clostilbegyt in hypogonadism (hypopituitarism) is ineffective, since increased gonadotropin secretion will not be observed due to their absence. In this situation, the use of natural gonadotropin preparations is indicated. Thus, stimulation of ovulation with clostilbegyt is effective only with normogonadotropic anovulation.

Drug can be a first-line therapy drug if ovulation stimulation is necessary in patients with polycystic ovary syndrome (in the absence of clomiphene resistance).

Clostilbegyt in infertility

Clostilbegyt in the treatment of infertility is an inexpensive, highly effective first-line drug for normogonadotropic anovulation. An important positive aspect of its use is the possibility of oral administration. However, the use of this drug is associated with a certain risk of complications and should be carried out only by a doctor, if possible, using ultrasound monitoring of folliculogenesis and endometrial development. In the vast majority of cases, the negative antiestrogenic effect of the drug on the thickness of the endometrium can be corrected by using estrogen-type drugs after the end of taking clostilbegyt in the planned fertility cycle.

In Vitro fertilization (IVF) for 40 years gives a chance to women who cannot get pregnant to have a long-awaited addition to the family, because the probability of pregnancy with IVF is even higher than naturally – 35% versus 20%, respectively. In this article, a reproductive therapist answers questions that are important for everyone who plans IVF to know.

There is an opinion that children born using IVF have genetic diseases and develop more slowly than children conceived naturally. How fair is it?

This stereotype has developed due to the fact that two or three embryos were transferred earlier. And, as a rule, with multiple pregnancies, children are born prematurely with developmental delay, and require careful monitoring and rehabilitation.

Currently, the principle of selective single embryo transfer prevails all over the world.

Scientists have found that such children do not differ from their peers, conceived naturally, for health reasons.

Is it true that vitamin D can directly affect the ability of couples to conceive?

Vitamin D not only regulates calcium metabolism, as is commonly believed. Vitamin D receptors are present in the organs of the male and female reproductive system, as well as the placenta. Therefore, it is so necessary for the onset of pregnancy.

It has been proven that more than 90% of infertile women have a reduced concentration of vitamin D. And in pregnant women, vitamin D deficiency can lead to adverse outcomes for the mother and fetus.

Are there complications after IVF?

Unfortunately, complications may occur at each stage of the IVF protocol. At the stage of stimulation, allergic reactions and the development of ovarian hyperstimulation syndrome are possible. The stage of transvaginal puncture may be complicated by bleeding. After the transfer of embryos into the uterine cavity, the risk of ectopic pregnancy is not excluded.

These complications are rare. In the arsenal of reproductologists there are tools that allow you to reduce the occurrence of these complications to a minimum.

How many attempts of IVF can be done without harm to health?

Exactly as long as it takes to achieve pregnancy. The main thing is that the break between stimulations is 2-3 menstrual cycles.

Is it true that repeated IVF attempts can provoke cancer?

It has been proven that the drugs used to stimulate superovulation (clomid is not included in this list) they do not cause oncological processes. We manage to eliminate all the associated risks at the stage of examination before IVF, namely, when detecting formations in the mammary glands or in the thyroid gland, a specialist’s opinion is required on the absence of contraindications for IVF.

What is the difference between IVF and hatching?

IVF and hatching are two components of the embiological stage. Only IVF is a method of fertilization, and hatching is an additional procedure that is done before transfer in order to implant embryos into the uterine cavity.

The embryo is protected from the external environment by a dense shiny shell. To attach to the endometrium (pregnancy), the embryo must independently exit it. When the embryo cannot leave the shell on its own, the embryologist makes an incision in it with a laser, which contributes to the exit of the embryo.

There is a concept of “psychological infertility” — what does it mean?

This is an unspoken diagnosis, which is “made” if it is not possible to get pregnant even after a comprehensive examination of a married couple and repeated IVF attempts with genetically healthy embryos.

Sometimes patients too zealously pursue the goal of becoming parents and are constantly waiting for pregnancy, which leads to depression or stress. Here is the time to seek help from a psychologist.

How to prepare for a visit to a reproductologist?

It is necessary to schedule a visit to the doctor for the 2-3 day of the menstrual cycle. It is desirable for a woman to take hormones such as AMH, FSH, LH, Estradiol, TSH, Prolactin. To the man – a spermogram and a MAR – test. Do not forget to bring statements and the results of previously passed tests to the reception.

Lack of ovulation: Certain processes occur regularly in a woman’s body that allow her to maintain reproductive function. The most important of them is ovulation – the release of an egg from the ovary. This stage falls approximately in the middle of the menstrual cycle. If there is no ovulation for one reason or another, then the fertilization process becomes impossible, respectively, a woman cannot become pregnant.

Physiological and pathological factors of lack of ovulation

The reasons for the lack of ovulation may not always be related to the disease. In some cases, there are natural physiological processes that occur in a woman’s body. The most typical example is pregnancy and breastfeeding. At this time, a woman lacks not only ovulation, but also menstruation.

The reasons for the lack of ovulation may be related to age-related changes. In a woman whose age exceeds 35 years, approximately every third cycle is anovulatory. Subsequently, the release of an egg from the ovaries is observed less and less and completely stops with menopause. Among other physiological reasons for the absence of ovulation, one can note a pronounced lack of body weight, taking certain hormonal drugs (oral contraceptives).

Reasons for the lack of ovulation
However, often a violation of the ovulation process is a direct consequence of various diseases. These include:

• ovarian pathology (inflammatory processes, benign and malignant tumors);
• diseases of the pituitary gland and hypothalamus;
• stress;
• pathology of the endocrine system;
• diseases of the adrenal glands, etc.

Some of these reasons for the lack of ovulation can lead to disruption of other processes in the body, so it is important to identify and eliminate them in a timely manner.

Reasons for the lack of ovulation

Anovulation is one of the most common causes of infertility. Various factors can provoke this condition.

The presence of diseases

The reasons for the lack of ovulation can be various hormonal disorders, polycystic ovary syndrome, endometriosis, thyroid pathology, congenital anomalies, tumors. Treatment in this case will consist in the identification and elimination of pathology. Only then can the normal physiological cycle be restored.

Discontinuation of hormonal medications

Anovulation as a result of taking oral contraceptives is a frequent occurrence. In most women, ovulation is restored already in the next cycle after the withdrawal of drugs, but in some cases the cycle can recover up to six months. In such a situation, it is recommended to consult a doctor and undergo an examination.

Body weight change

Adipose tissue is not just our “reserves”, it also affects hormonal metabolism, which can affect, among other things, reproductive function. Similar changes can occur with a sharp weight loss or too low body mass index in summer. Therefore, both obesity and weight deficiency can be the reasons for the lack of ovulation. At the same time, it can be very difficult to restore the cycle without normalization of BMI.

Increased physical activity

Usually this factor is detected in professional athletes. Regular and excessively high physical exertion, combined with a weakly expressed fat layer, mental and physical fatigue, and especially taking hormonal drugs to achieve high results, cause the absence of ovulation. As a rule, after reducing the intensity and frequency of training, this violation disappears.

Change of situation

Frequent change of time zones, moving to a country with a different climate, changing habitual living conditions are accompanied by stress, against which the menstrual cycle may be disrupted and ovulation may disappear. Usually these conditions are temporary and disappear after the stress factor is eliminated.

Menopause

This natural process is accompanied by a gradual extinction of ovarian function. Accordingly, the absence of ovulation during menopause is a natural phenomenon. The average age of menopause is 50 years. This condition is preceded by premenopause, which begins at 45-47 years. It is accompanied by symptoms such as an irregular monthly cycle and irregular ovulation. In the future, menstruation and ovulation completely stops.

Thus, the reasons for the absence of ovulation can be very diverse and do not always indicate the presence of any diseases. It is not easy to determine them yourself. If a woman does not become pregnant for a long time, it is necessary to consult a doctor, undergo an examination and follow exactly the prescribed treatment plan, for example, follow the schedule of taking clomid and other doctor’s prescriptions.

Methods for diagnosing the lack of ovulation

It is very difficult to independently determine the cause of the absence of ovulation. However, the problem may manifest itself with certain symptoms, which include:

• irregular menstrual cycle;
• complete absence of menstruation;
• basal temperature measurement;
• severe bleeding during menstruation;
• no signs of premenstrual syndrome.

If a woman notices such changes in her state of health, she should make an appointment with a gynecologist as soon as possible.

In order to identify the exact cause of the absence of ovulation, the specialist prescribes a comprehensive examination, which includes the following methods:

• determination of the level of sex hormones in the blood;
• Ultrasound of the ovaries, thyroid gland, abdominal cavity and pelvic organs;
• vaginal swabs;
• tests for sexually transmitted infections.

After the reason for the absence of ovulation is identified, the doctor will be able to prescribe the necessary treatment.

Anovulatory cycle – how to wake up sleeping eggs. In the ovary there are special structures – follicles in which eggs mature. In the middle of the cycle, the follicle ruptures, releasing the mature germ cell into the fallopian tube to meet the sperm. However, in some cases, the egg does not leave its container and does not seek to fertilize.

Cycles that are not accompanied by ovulation are called anovulatory. Such a violation leads to infertility.

How the female body works and why nature fails

Normally , the menstrual cycle is divided into three phases:

• Follicular, occurring after the end of menstrual bleeding. During it, the cerebral appendage – the pituitary gland – secretes follicle-stimulating hormone (FSH), which “spurs” the development of follicles, one or two of which will burst in the middle of the cycle and release mature eggs. In parallel, the ovaries increase the production of female hormones-estrogens, especially estradiol.
• Ovulatory – closer to the end of egg maturation, the production of another hormone – luteinizing (LH) begins. Under its influence, ovulation occurs. The follicle bursts, and the egg goes into the fallopian tube to meet the sperm.
• The phase of the corpus luteum, during which the fertilized cell descends into the uterus and is implanted. The burst follicle turns into a yellow body, secretes progesterone and sex hormones necessary to maintain pregnancy.

With an anovulatory cycle, this system gets lost. Most often, the violation is associated with a change in the concentration of female hormones, which may be too much or too little. Due to hormonal imbalance, there is a significant thickening of the inner uterine layer – the endometrium.

After reaching a certain limit, the mucosa begins to peel off, which leads to a violation of the integrity of the vessels and menstrual bleeding. Its strength and duration can be different and vary from month to month. The constant thickening of the mucosa leads to the formation of polyps – mushroom-like growths, which further complicate fertilization.

In some periods of life, for example, in puberty (adolescence) and when entering menopause, this situation is considered the norm and does not require treatment. Periodic anovulatory cycles in a healthy woman are also not dangerous. Medical care is required if there is a constant absence of ovulation, which does not allow getting pregnant and negatively affects the state of health.

Causes of anovulatory cycles

• Pathologies of the pituitary gland – the cerebral process that secretes hormones that ensure the maturation of the follicle and the release of the egg. The causes of his work disorders may be brain injuries, infections or congenital underdevelopment.
• Prolactinemia is the production of prolactin, which normally should be responsible for breastfeeding, milk production and inhibit ovulation during breastfeeding. However, in some cases, the concentration of this hormonal substance increases outside the lactation period, leading to inhibition of egg development. The causes of this phenomenon are pituitary tumors, taking certain medications, cirrhosis of the liver, kidney diseases.
• Diseases of the thyroid gland, the hormones of which affect the work of all body systems. Thyroid insufficiency inhibits ovulation, and in severe cases can lead to amenorrhea – the cessation of menstruation.
• Adrenal hyperfunction. Anovulatory cycles occur with increased production of male hormones by these organs – androgens.
• Pathological processes in the ovaries that disrupt the production of female hormonal substances – estrogens. Such a condition can provoke cysts and chronic adnexitis (inflammation). Anovulatory cycles are common for polycystic ovarian disease, in which the eggs do not ovulate, but remain inside the follicles, turning into small cysts.
• An abortion performed at a late date. In this situation, the body, which has tuned in to carrying a child, gets the strongest stress. Hormonal failure occurs, leading to the shutdown of ovulation.

Symptoms of the anovulatory cycle

The complaints accompanying this violation depend on the level of hormones:

With a normal hormonal background, the absence of ovulation does not cause any complaints. According to the number of days and the volume of blood lost, the menstrual-like reaction that has occurred fits perfectly into the standard critical days. The patient learns about the problem when she decides to have a child. Conception does not occur in any way, and by contacting a doctor, the patient learns about the existing violation that led to infertility.

With increased production of female estrogen hormones – hyperestrogenism – prolonged copious menstrual discharge may occur, leading to anemia (anemia). Sometimes, due to hormonal imbalance, blood clotting decreases, which aggravates the situation.

With a decrease in the amount of female hormones – hypoestrogenia – menstruation becomes short, sparse, irregular.

Treatment anovulatory cycle

A woman is prescribed ovulation stimulation with the help of medications that affect the growth of eggs and their exit from the follicle. Medications allow you to “wake up” follicles containing eggs. The process is controlled by a gynecologist, who prescribes periodic ultrasound examinations of the ovaries, fixing the exit of germ cells into the fallopian tubes.

Against the background of the treatment, the possibility of pregnancy increases by 70%. However, artificial ovulation often knocks out several eggs from the ovaries, which increases the likelihood of multiple pregnancies.