Stimulation of ovulation of PCOS. Part 2.

We continue our articles about pregnancy with a diagnosis of PCOS. You can read the first part here.


In Chile, a plenary session was held in 2002, the result of which was the first summation of data on the use of CC for ovulation induction, including in PCOS. It was noted that CC can be used in PCOS as monotherapy, in combination with gonadotropins, and in case of detected insulin resistance (IR) (using Caro and HOMA indices) — with metformin (MF). The main side effects of CC remain-the risk of multiple pregnancies, ovarian hyperstimulation syndrome and ovarian cancer. Later, studies began to appear in which it was noted that CC is most often ineffective at low doses in women with PCOS and obesity, and at higher doses (> 150 mg) it is often accompanied by hyperstimulated ovarian syndrome. And in such cases, a combination of CC and MF is more effective.

The important question remains, what is the percentage of pregnancy in women with PCOS during CC treatment? It was found that the restoration of ovulation with the use of CC occurs in 80%, and pregnancy-only in 35-40% of patients. The authors themselves associated this with the antiestrogen effect of CC at the level of the endometrium and cervical mucus. In addition, 20-25% of women with PCOS are clomiphene-resistant, and, as a rule, these are women with obesity, IR and severe hyperandrogenism.

Due to the need to discuss issues and summarize data on the treatment of PCOS in Greece, an ESHRE/ASRM consensus was held in 2007, which resulted in a synthesis of the data available at that time. The first-line drug was called CC, the second-line drug was gonadotropins, the next step in case of ineffectiveness of conservative therapy is the surgical method of treatment-electrocauterization of both ovaries (ECOI). The use of MF in women with PCOS should be limited and used only in those who have been diagnosed with a violation of glucose tolerance (HTH). The insufficient number of studies conducted in the field of biguanide use does not give a complete picture of this group of drugs for ovulation induction.

PCOS

In 2009, the data of a comparative study on the use of CC, MF and their combination for ovulation induction were published. The randomized study involved 115 women who were divided into three groups. In the MF group, ovulation was achieved in 23.7%, in the CC group-in 59%, and in the combination of these drugs — in 68.4%, the birth rate was 7.9%, 15.4%, 21.1%, respectively.

Due to the lack of algorithms for the treatment of women with PCOS (taking into account age, anamnesis of the disease, the presence or absence of IR, etc.), the age of initiation of CC therapy is determined individually for each patient. In 2009, Badawy et al. published the results of a study in which they showed that the earlier a CT scan is prescribed in women with PCOS, the more pronounced the follicular growth in the ovaries, the thickness of the endometrium will be and, thus, the percentage of pregnancy will increase.

to be continued…

Stimulation of ovulation of polycystic ovary syndrome

Today we are starting a series of articles about the ovulation stimulation of polycystic ovary syndrome, we are publishing the first part.

Polycystic ovary syndrome (PCOS) is the most common form of endocrinopathy, it occurs in 5-10% of women of reproductive age and accounts for 80%, and according to some data, even 90% of all forms of hyperandrogenism.

The classic picture of PCOS, or sclerocystic ovaries, was described by Stein and Leventhal in 1935 as a syndrome of amenorrhea and enlarged ovaries, combined in 2/3 of cases with hirsutism and in every second case with obesity. However, later it was noted the existence of a wide variety of forms of the syndrome, manifested by a significant variation in the clinical picture of the disease, the endocrine profile and morphological features of the classic syndrome, in connection with which the term “polycystic ovary syndrome”was proposed. In recent years, the concept has been put forward, which has received universal approval, that the clinical manifestations associated with PCOS should be interpreted precisely as a syndrome, and not as a disease, this is a more accurate and specific term.

The etiology and pathogenesis of PCOS are still not fully understood, despite the huge number of studies devoted to this problem.

Ovulation stimulation and the Rotterdam Consensus

The final document of the Rotterdam Consensus (2003) stated that PCOS remains a diagnosis that requires the exclusion of other known disorders that manifest themselves as universal clinical signs of hyperandrogenism, and therefore can mimic and occur “under the mask” of PCOS. While PCOS itself is a syndrome of ovarian dysfunction (irregular menstruation, anovulation, infertility), the specific manifestations of which include not only hyperandrogenism, but also the “polycystic” morphology of the ovaries. Thus, for the first time, an agreement was reached on the need to give an ultrasound assessment of the size and structure of ovarian tissue a significant diagnostic criterion.

ovulation stimulation

According to the consensus, the presence of at least two of the three criteria makes it possible to verify the diagnosis of PCOS after excluding other conditions. Thus, on the one hand, in terms of examination, PCOS remains a syndrome (a complex of symptoms), the identification of which is impossible and unacceptable on the basis of the isolated presence of any single diagnostic criterion. On the other hand, a simple analysis of the pairwise combination of modern criteria allows us to draw a fundamental conclusion about the need for an expanded interpretation of the term PCOS. This is due to the additional inclusion of new clinical forms in its definition, namely: in the absence of another hyperandrogenic pathology, the diagnosis of PCOS is permissible not only in the classical course (a complete triad of signs), but also in the presence of one of three incomplete (non-classical) clinical and instrumental duets.

It is known that PCOS accounts for 56.2% of all forms of endocrine infertility. Currently, it is believed that the main ways to restore fertility in patients with PCOS should be considered assisted reproductive technologies( ART), the purpose of which is not to treat a woman, but to achieve pregnancy in a specific cycle of ovulation stimulation. The concept of ART includes not only methods of in vitro fertilization (IVF), but also conception in a natural way as a result of various methods of ovulation induction.

The leading link in the structure of assisted reproductive technologies in PCOS is the induction of ovulation. For this purpose, various medications are used individually — derivatives of chlortrianisene – clomiphene citrate (CC) and its analogues, combined oral contraceptives, gonadotropins, gonadotropin-releasing hormone analogues, insulin sensitizers, aromatase inhibitors.

The drug of choice for anovulation is considered to be CC, which was first synthesized in 1956 by WS Merrell for contraceptive purposes. Initially, CC was used for endometrial cancer during the preparation of patients for surgery, but during surgical interventions, yellow bodies in the ovaries and secretory transformation of the endometrium were accidentally discovered, which served as the basis for the use of CC as an ovulation inducer, and since 1967, the use of the drug in patients with anovulatory dysfunction began. Is CC a first-line drug for the treatment of infertility in women with PCOS? This question has arisen throughout the use of this selective estrogen receptor modulator, and there is still no clear answer: whether to use it as monotherapy or in combination with other drugs.

to be continued…

Age-related androgen deficiency syndrome in men

The syndrome of age-related androgen deficiency in men is a violation of the biochemical balance that occurs in adulthood due to a lack of androgens in the blood serum, often accompanied by a decrease in the body’s sensitivity to androgens. As a rule, this leads to a significant deterioration in the quality of life and adversely affects the functions of almost all body systems. Naturally, the issues of androgen deficiency therapy are of great interest, since it poses a difficult task for a clinician: to choose from a wide arsenal of methods and drugs of hormone therapy the most optimal, combining quality, efficiency, and ease of use.

Currently, urologists and andrologists most often use testosterone replacement therapy. This method allows you to solve a number of tasks: to reduce the symptoms of age-related androgen deficiency by increasing libido, overall sexual satisfaction, to reduce the severity or completely eliminate vegetative-vascular and mental disorders. In addition, if testosterone replacement therapy is used for more than 1 year, patients experience an increase in bone density, a decrease in the severity of visceral obesity, as well as an increase in muscle mass. Also, after a long course of treatment, laboratory parameters are normalized: there is an increase in the level of hemoglobin or the number of red blood cells, a decrease in the level of VLDL (very low-density lipoproteins) and LDL (low-density lipoproteins) with an unchanged level of HDL (high-density lipoproteins). Many authors believe that such an effect can be achieved by restoring the concentration of testosterone in the blood to a normal level (10-35 nmol/l). It should also be taken into account that * 17α-alkylated testosterone preparations fluoxymesterolone and methyltestosterone have pronounced hepatotoxicity, having a toxic and carcinogenic effect on the liver, and also negatively affect the blood lipid spectrum (a sharp increase in the level of atherogenic and a decrease in the level of anti-atherogenic lipoproteins). Therefore, the use of these testosterone derivatives in clinical practice was discontinued.

Currently, testosterone undecanoate is preferred among oral medications. This testosterone ester is not subjected to primary hepatic metabolism, since it is absorbed into the lymphatic system, bypassing the liver. After the hydrolysis of testosterone undecanoate in the lymphatic system, testosterone enters the systemic bloodstream, which has a therapeutic effect both by itself and through its main metabolites-dihydrotestosterone (DHT) and estradiol, which cause the full spectrum of androgenic activity of testosterone. Thus, testosterone undecanoate retains its activity when administered orally. At the same time, bypassing the portal vein system and passing through the liver, testosterone undecanoate does not have hepatotoxic and hepatocancerogenic effects. The half-life of the drug from the plasma is 3-4 hours. In this regard, the dosage regimen of testosterone undecanoate is a 2-fold intake during the day, this is not always convenient for patients. Based on our own experience, we believe that Andriol is a fairly mild drug and helps only in cases of initial and minimal manifestations of age-related androgen deficiency.

androgen deficiency

Intramuscular injections of prolonged testosterone esters are also a widely used method of substitution therapy in men with hypogonadism. The two most well – known esters of testosterone, testosterone cypionate and testosterone enanthate, have similar pharmacokinetics. With intramuscular administration of these drugs, a depot is created from which the drug is released into the bloodstream. During the first 2-3 days after administration, the testosterone level rises to supraphysiological figures, and then slowly decreases over the next 2 weeks to subnormal values. The positive side of these drugs is the duration of the therapeutic effect. Nevertheless, sharp changes in the level of testosterone, often felt by the patient himself in the form of rises and decreases in libido, general well-being, emotional status, are undesirable qualities of these drugs. In this regard, great hopes are pinned on the new drug Nebido (Sharing), the pharmacokinetics of which is significantly different from other testosterone esters. Nebido is a testosterone undecanoate and is a drug that does not have a peak increase in concentration.

Over the past two decades, much attention has been paid to the study of the benefits of transdermal use of testosterone preparations. Scrotal patches have an effective effect, and some patients consider them the most convenient method of treatment. Skin patches are most well perceived by patients and give an effective level of testosterone in the blood serum. Nevertheless, there are some differences between these two types of patches regarding their allergogenic potential: when using skin patches, there is a much higher frequency of allergic reactions and skin irritation than when using scrotal patches. Testosterone gel has all the advantages of patches and does not cause the development of skin reactions. Its only drawback is the possibility of contact of the gel with a partner and an insufficient number of long-term studies on its use.

The transdermal route of testosterone administration allows avoiding its primary metabolism in the liver and inactivation, as it happens when using oral androgenic drugs, and also allows simulating the circadian rhythms of the release of physiological unmodified testosterone and its natural metabolites, estradiol and DHT. In addition, therapy with the use of patches and gel can be easily interrupted if necessary. The positive aspects of this method of treatment also include a low risk of drug dependence.

Although the European drug 5-α-dihydrotestosterone gel (DHT) is recognized as effective, it is not known whether the isolated use of a non-aromatized androgen, such as DHT, has the same effect as testosterone, due to the fact that testosterone metabolites include estradiol. According to many authors, the use of the drug is not recommended, since DHT, due to the inability to convert into estradiol, does not have the full range of therapeutic properties of testosterone (for example, the effect on bone tissue and the cardiovascular system).

Thus, we can say that there is no optimal remedy for the treatment of age-related androgen deficiency in men. And the choice of the drug should be approached strictly individually, taking into account the patient’s age, body mass index, the need to preserve spermatogenesis, hematocrit indicators and concomitant diseases.

Female and male infertility: part 2

Male infertility: The maturation of spermatozoa in the testicles occurs under the influence of gonadotropins secreted by the pituitary gland, and male sex hormones (androgens). Unlike the female body, there is no cyclicity in the regulation of the male reproductive system.

Diagnosis and treatment of male infertility

The sexual potency of a man is not an indicator of his fertility, since the ability to fertilize is determined by the quality of spermatozoa. In men, in addition to determining the level of male sex hormones and their daily rhythm, it is necessary to examine the spermogram before, during and after treatment. Male fertility is determined by the following key factors: spermatogenesis, sperm transport, the ability of the sperm to penetrate into the egg to introduce genetic material into it.

To identify the causes of infertility, it is important to know the following features of sperm transport. The seminal fluid forms a gel almost immediately after ejaculation, but after 20-30 minutes it is liquefied under the influence of enzymes coming from the prostate gland. In some cases, the seminal fluid remains viscous, retains spermatozoa and prevents them from moving into the uterus. Normally, the acidity of the seminal fluid is higher than 6 pH, which protects the spermatozoa from the harmful effects of the acidic pH of the vagina.

Male infertility

On the way from the vagina to the tubes, the number of spermatozoa decreases significantly. On average, out of 200-300 million spermatozoa that have entered the vagina, eggs reach less than 200. Some of the spermatozoa are destroyed under the influence of vaginal enzymes, as well as as a result of “squeezing” the seminal fluid from the entrance to the vagina. The largest number of spermatozoa dies during passage through the fallopian tubes. Phagocytosis of spermatozoa occurs throughout the reproductive tract.

Examination and treatment of patients to determine the cause of infertility is carried out by an andrologist or urologist.

Examination of a man with infertility begins with the analysis of a spermogram, which allows you to determine the volume of sperm, the total number of spermatozoa, the number of active and normal spermatozoa. In addition, the number of white blood cells is calculated, the viscosity of the sperm is determined, the dilution time is determined. The lack of dilution of seminal fluid is one of the causes of male infertility.

Another factor leading to male infertility may be sperm agglutination. At times, this happens in most men. However, the detection of sperm agglutination in repeated samples indicates an autoimmune reaction or infection. If a large number of abnormal spermatozoa are detected, an additional study is shown – a morphological analysis of sperm. Based on the conducted studies, the nature of the pathology of spermatozoa is established and the method of infertility treatment is determined. The maturation of spermatozoa largely depends on the impact of internal and external adverse factors. Alcohol, nicotine, occupational hazards, stress, nervous and general fatigue, acute and chronic diseases worsen the quality of sperm.

The composition of spermatozoa is resumed within three months. This should be taken into account when submitting sperm for analysis. The longer it is possible to maintain a healthy lifestyle, the better the result. Before submitting sperm for analysis, it is necessary to refrain from sexual contact for 3-5 days. Compliance with this condition allows you to get the best composition and quality of spermatozoa. Daily or more frequent ejaculations can lead to a decrease in the quality of spermatozoa, but abstinence for 5-7 days or longer is also undesirable, since an increase in the number of spermatozoa does not contribute to the “preservation of sperm” (as some patients believe), but is accompanied by a decrease in their mobility as a result of an increase in the proportion of old cells.

The most common causes of male infertility are:

  • inflammatory diseases (prostatitis, urethritis, etc.);
  • obstruction (obturation) of the vas deferens;
  • dilation of the veins of the spermatic cord (varicocele);
  • hormonal and sexual disorders.

It is not always possible to identify all possible causes of infertility. The male factor of infertility occurs in 40% of cases; unidentified causes-in 10%.

During the examination, physical disorders may be detected, for example, pronounced hypospadias, in which sperm does not enter the vagina. It is extremely rare for diabetes mellitus, neurological disorders, after prostatectomy, retrograde ejaculation of sperm into the bladder can occur.

In some cases, to find out the cause of infertility, in addition to a spermogram, a testicular biopsy should be performed. Azoospermia (the absence of spermatozoa in the sperm fluid) in the presence of spermatogenesis indicates an obstruction of the ducts. If a biopsy reveals complete hyalinization and fibrosis of the seminal tubules, the possibility of fertility is almost excluded.

The most common cause of male infertility is inflammatory processes directly in the testicles (orchitis, orchiepididymitis) and in the vas deferens (epididymitis, differentitis, vesiculitis). Approximately 15-20% of men who have suffered from mumps have orchitis, which in half of the cases ends with hypoplasia of the testicles of various degrees. If an infection of the genitourinary tract is detected, antibacterial therapy and, possibly, prostate massage should be prescribed.

25% of infertile men have varicose veins of the left internal seminal vein, the ligation of which in 50% of cases determines the possibility of fertilization. With clinically expressed varicocele, the size of the left testicle is usually reduced. It should be noted that varicocele is detected in 10-15% of men in the general population, and about half of them have violations of the spermogram. Even a weakly expressed varicocele can affect the quality of sperm, which is associated with an increase in the temperature of the testicles. Men with a normal spermogram, but who have been diagnosed with varicocele, need periodic examination, because their spermogram indicators may worsen over time.

Endocrine disorders rarely cause male infertility. Nevertheless, it is necessary to study the content of FSH, LH, testosterone and prolactin. If an increased level of prolactin is detected, a further diagnostic examination is performed to identify/exclude a pituitary tumor.

There are cases of infertile marriage, when both sexual partners are healthy, and pregnancy does not occur. This is often due to their immunological incompatibility, when antibodies to spermatozoa are produced in a woman’s body. These proteins inhibit the motility of spermatozoa and their ability to fertilize an egg.

There are special methods for diagnosing immunological incompatibility. The simplest of them – the postcoital test-allows you to get information about the absorbing ability of cervical mucus, as well as about the ability of spermatozoa to reach it and survive in it. The test is planned for the expected day of ovulation, which is determined by the previous basal temperature maps, the duration of previous cycles and the degree of humidity of the vagina. The cervical mucus is taken no later than 12 hours after coitus with the previous 48-hour abstinence; the cervical mucus is taken with tweezers. The extensibility of the mucus should be at least 8-10 cm. The mucus obtained during ovulation contains 90-95% water; it should be watery, liquid, transparent and abundant, and also should not contain cells. When drying on a slide, the mucus resembles a fern leaf. Mucus before ovulation and starting from 24-48 hours after it has a thick and viscous consistency, dries out in the form of amorphous lumps. The mucus of the optimal composition for the survival of spermatozoa usually persists for 2-3 days, but it varies from 1 to 5 days and even longer for different women. The normal number detected by a postcoital test is considered to be from 1 to 20 spermatozoa in the field of vision. If repeated tests do not detect spermatozoa or only find immobile cells, the prognosis is less favorable than when detecting live spermatozoa. Treatment becomes unsuccessful, especially in cases when repeated postcoital tests do not find spermatozoa or only dead forms are found, despite good mucus and a spermogram.

Male and female infertility

There are primary and secondary female infertility. Primary infertility is spoken of if a woman has not had a single pregnancy, despite regular sexual activity for a year in the absence of contraception, secondary – if there is a pregnancy earlier, that is, if it is impossible to conceive a child after an abortion, ectopic pregnancy, miscarriage, or the birth of a child. Voluntary infertility can be called a situation if pregnancy is undesirable and a woman is protected using contraceptives. There are also absolute infertility, when conception is impossible due to congenital pathology or irreversible changes in the woman’s body, and relative infertility, when the ability to fertilize is not impaired; in such cases, it is appropriate to talk about reduced fertility.

The inability of a mature woman’s body to conceive is due to the following reasons:

  • endocrine disorders – anovulation) – 40%;
  • tubal-peritoneal factor-30%;
  • gynecological diseases – 15-25%;
  • immunological factor – 3%;
  • unidentified factors-2-3%.

The main cause of ovarian infertility is anovulation – a violation of the menstrual cycle, as a result of which the maturation and release of the egg from the follicle does not occur. Endocrine (anovulatory) infertility can have different origins: hypothalamic, hypothalamic-pituitary, ovarian, thyroid and adrenal gland diseases, chromosomal abnormalities, violation of implantation of a fertilized egg, violation of the function of the fallopian tubes, etc.

Etiological factors of anovulatory infertility

Hypothalamic causes. Hypothalamic gonadoliberin deficiency (gonadotropin-releasing hormone-GnRH) leads to a violation of the regulation of the gonadotropic function of the pituitary gland and, accordingly, ovarian function; clinically manifested by anovulation. Violation of GnRH secretion can occur with emotional overstrain, weight loss, under the influence of medications.

Pituitary causes. Micro-and macroadenomas of the anterior pituitary lobe, prolactinomas can lead to pathological hyperprolactinemia. In all cases, if a pituitary adenoma is suspected, magnetic resonance imaging (MRI) is necessary. A slight increase in the level of prolactin, most often temporary, can occur with emotional overstrain.

Ovarian causes. There are primary and secondary ovarian insufficiency. The cause of primary ovarian insufficiency is ovarian pathology, secondary-a decrease in the secretion of GnRH in the hypothalamus or gonadotropin hormones in the adenohypophysis. Premature ovarian insufficiency may have a genetically determined, autoimmune, idiopathic, functional (weight loss, physical activity, medications) origin.

The most common cause of ovarian anovulation (female infertility) is polycystic ovary syndrome. Often, the syndrome of luteinization of a non-ovulated follicle is detected. This condition can be caused by some medications (prostaglandin synthetase inhibitors), it is often observed in endometriosis, stress, hyperandrogenism, hyperprolactinemia, inflammatory processes in the ovaries. The diagnosis is established on the basis of ultrasound (ultrasound) or laparoscopy data.

The thyroid gland and the adrenal glands. Hypothyroidism or hyperthyroidism is accompanied by a violation of the function of the pituitary gland, ovaries, which leads to anovulation. In Itsenko-Cushing’s disease and other cases of hypercortisolemia, elevated levels of testosterone and cortisol cause suppression of the gonadotropic function of the pituitary gland, as well as ovarian dysfunction, while secondary polycystic ovaries may develop.

Chromosomal abnormalities lead to amenorrhea and are also accompanied by infertility.

Violation of the implantation of a fertilized egg occurs as a result of a decrease in the level of progesterone; it can be caused by deformation of the uterine cavity with submucosal uterine fibroids.

Violation of the function of the fallopian tubes can be a consequence of inflammatory processes of the uterine appendages, which lead to a violation of the capture of the oocyte as a result of the formation of peritubar adhesions and damage to the fimbria, as well as damage to the epithelium of the tubes. The function of the fallopian tubes can be impaired with endometriosis, destructive appendicitis, suppuration after surgery on the pelvic organs or abdominal cavity.

Smoking, alcohol abuse, drug use, psychological factors, and adverse environmental effects can contribute to a decrease in fertility.

Female infertility: Diagnostics

To determine the cause of female infertility, it is necessary to study the hormonal status, conduct ultrasound of the pelvic organs, adrenal glands, analyze the physical, mental and social health of the patient and compare it with the course of the disease, as well as with the results of the treatment. The study of the quality of life allows us to optimize tactics and strategy in the treatment of women with various diseases of the reproductive system.

The following diagnostic tests are performed:

  • determination of functional changes in the ovaries and uterus;
  • detection of urogenital tract infection;
  • assessment of the state of the uterine cavity and patency of the fallopian tubes;
  • identification of an immunological conflict between spouses.

The most informative studies of the hormonal function of the ovaries are ultrasound and hormonal monitoring, supplemented by basal temperature measurement. In infertility, the examination of patients should begin with determining the level of luteinizing (LH) and follicle-stimulating (FSH) hormones in the blood. In the early follicular phase of the cycle, the level of FSH should be below 3-5 IU/l. Exceeding the standard values indicates that the biological age of the ovaries is older than the chronological age of the woman. The study of the FSH content should be carried out together with the determination of the level of estradiol, since at the concentration of estradiol above 250 pmol/l, the level of FSH decreases (by the negative feedback mechanism). To exclude polycystic ovary syndrome, the ratio of LH/FSH is additionally calculated.

To assess the state of carbohydrate metabolism, you should measure the level of glucose and insulin in the blood on an empty stomach. If necessary, a glucose tolerance test is performed. In the middle of the luteal phase of the cycle, the level of progesterone is determined (5-7 days after the basal temperature rises). The function of the thyroid gland and the level of blood prolactin are studied.

Recently, it is recommended to start the examination of patients with infertility with a study of the content of prolactin in the blood, since an increased level of prolactin is diagnosed in 20-25% of patients with infertility and various menstrual cycle disorders, and in 40-45% of them, macro – and micro-tumors of the pituitary gland are the cause of hyperprolactinemia.

Ultrasound of the pelvic organs is performed at the initial stages of examination of patients with infertility, and hysterosalpingography – in the follicular phase of the cycle.

Female infertility: Treatment of hormonal infertility

In the treatment of anovulatory infertility, clomiphene citrate or gonadotropin preparations prepared from the urine of pregnant or postmenopausal women, and in recent years – obtained by genetic engineering, are prescribed to restore fertility.

female infertility

Clomiphene citrate is an antiestrogenic drug that has the ability to bind estradiol receptors in all target organs, including the hypothalamus, at the site of GnRH synthesis, which causes an increase in the secretion of gonadotropins and especially FSH. An increase in the level of FSH stimulates the maturation of follicles in the ovaries and leads to an increase in the concentration of estradiol. By suppressing the regulatory effect of endogenous estrogens, clomiphene citrate blocks the normal feedback mechanism, which causes an increase in the frequency of cyclic GnRH secretion. The drug is prescribed from the 2nd day of the menstrual cycle for 25-50 mg or 100 mg for 5 days, and in the case of amenorrhea – from the 2nd day of the induced menstrual cycle. Patients with polycystic ovary syndrome have an increased sensitivity to drugs that stimulate ovulation, so such patients are prescribed clomiphene citrate at a dose of no more than 25-50 mg. The effectiveness of treatment is evaluated using ultrasound. From the 9th-10th day of the menstrual cycle, the diameter of the dominant follicle should be monitored, and on the 13th-14th day – the preovulatory follicle, which should have a size of 16-26 mm. If the disappearance or gradual decrease of the dominant follicle is recorded during ultrasound, ovulation has occurred. If three or more follicles with a size of 18-22 mm are detected according to ultrasound data, sexual contact should be avoided. The level of serum progesterone exceeding 20 nmol/l on the 21st day of the menstrual cycle indicates ovulation.

Currently, ovulation stimulation is recommended for no longer than 6 months, which is associated with an increased risk of ovarian cancer when taking clomiphene citrate for more than 12 months. In real practice, due to frequent dose adjustment, the drug is often used for a longer time.

Of the side effects of clomiphene citrate, hot flashes are most often noted, which occur in 10% of cases and disappear after stopping taking the drug. Sometimes, against the background of clomiphene citrate therapy, an increase in the size of the ovaries may occur. Rarely, patients note such undesirable phenomena as nausea, vomiting, depression, nervousness, fatigue, insomnia, headache, weight gain, pain in the mammary glands. When prescribing high doses of the drug to patients with polycystic ovary syndrome, the frequency of side effects increases. In the absence of the effect of the use of clomiphene citrate in such patients, laparoscopic diathermocoagulation of the ovaries or the appointment of gonadotropins is necessary.

We talked about female infertility today, we will write about male infertility in our next article, stay with us on this blog and recommend us to your friends and acquaintances. We remind you that you can also buy Clomid using our referral link, which is located in the blog header!

The mechanism of action of clomiphene and its effectiveness

Action of clomiphene: According to the hypothesis, clomiphene directly stimulates the hypothalamus-pituitary-ovary system, which in turn affects the gynothalamic-pituitary system. This hypothesis is confirmed by clinical data that have shown the possibility of increasing the release of estrogens after taking clomiphene without first increasing FSH.

This hypothesis is also confirmed in experimental studies. Thus, Smith and Doy showed that when clomiphene is added to a medium containing testosterone and placental microsomes, the production of estrogens from testosterone increases by 1.6 times. The Hammerstein data indicate the possibility of enhancing the synthesis of progesterone from acetate in the human yellow body (in vitro) with the addition of large amounts of clomiphene by activating the 3-b-ol-dehydrogenase enzyme system. At the same time, with an increase in the dose of clomiphene, the synthesis of progesterone is sharply inhibited.

According to Israel, both assumptions should be accepted as important working hypotheses; obviously, clomiphene has the possibility of a dual effect, which is confirmed by an increase in the excretion of both gonadotropins and estrogens in women with removed ovaries. This can be explained by enzyme changes in the biosynthesis of estrogens not only in the ovary, but also in the adrenal gland, which causes an increase in the synthesis of estradiol, which in turn causes the release of gonadotropins necessary for ovulation.

Currently, it is known that clomiphene increases the release of FSH and LH as a result of binding to estrogen-dependent receptors of the hypothalamus, which causes the development of a follicle in the ovary and the appearance of an estradiol peak preceding the ovulatory peak of gonadotropins. At the same time, estrogens increase the sensitivity of the pituitary gland to Gn-RH and the ovaries to gonadotropins, which leads to ovulation. A partially local effect of clomiphene on the ovary is also possible.

Action of clomiphene

Thus, clomiphene performs its biological effect mainly due to its anti-estrogenic effect, which activates the gonadotropic function of the pituitary gland. Clomiphene has found wide application for the treatment of patients with endocrine forms of infertility due to its ability to stimulate ovulation.

Clomiphene can be used in patients with mild ovarian hypofunction, an incomplete luteal phase, with dysfunctional uterine bleeding, oligomenorrhea, as well as in women with sclerocystic ovaries. Clomiphene is also used in patients with amenorrhea as a functional test before treatment with hopadotropins and in combination therapy in combination with gonadotropins. The drug is usually prescribed for 50-100 mg, starting from the 5th day of the menstrual cycle or from the 5th day from the beginning of a menstrual-like reaction caused by progesterone.

action of clomiphene

The course of treatment usually lasts 5-7 days. In the absence of an effect, the dose of clomiphene is increased to 100-200 mg per day and repeated courses of treatment are prescribed, sometimes up to 5-6. To illustrate the dependence of the effectiveness of treatment on the dose of the drug, we present data from Roland.

Most often, ovulation occurs during the first course of treatment with small doses (50 mg for 5 days). Inslcr and Lunenfeld believe that it is still necessary to prove the existence of a relationship between the dose of the drug and the level of increase in gonadotropins, as well as the frequency of ovulation. Among patients who have ovulation, the percentage of pregnancy varies between 15-30.

According to the summary data of the Merrell laboratory, which synthesized action of clomiphene for clinical use for the first time, 1,454 out of 5,569 patients (24%) had 1,654 pregnancies; 1,223 of them were full-term, and 100 women had twins or triplets. In 22% of cases, the pregnancy ended with a spontaneous abortion. This percentage is quite high if we compare these data with the number of spontaneous abortions in “healthy” women (10%). At the same time, in women who have suffered from primary infertility for a long time, the percentage of spontaneous abortions is 20, and in secondary infertility — 24.8

Thus, the frequency of spontaneous abortions in patients treated with clomiphene is approximately the same as in women suffering from infertility, when treated with other methods. According to the summary data of this laboratory, 28 out of 1938 fetuses (1.44%) had such malformations as cleavage of the upper lip and palate, polydactyly, Down’s disease, microcephaly.

Controlled Ovulation Induction (CIO)

Controlled ovulation induction: Modern approaches to the diagnosis and treatment of infertility are based on knowledge of the fundamental foundations of the physiology of the female reproductive system, suggesting a decrease in reproductive potential and the ability to conceive with increasing age. It is known that the loss of oocytes begins at the age of 27, the peak of which falls on 35-37 years. In this regard, infertility treatment should be carried out using modern methods that have proven their effectiveness in quickly and successfully achieving pregnancy.

According to the recommendations of leading professional associations and international organizations (WHO, ESHRE, ASRM, MSAR), infertility should immediately begin examination and treatment of patients in the following cases:

  1. In the absence of pregnancy for 12 months of active sexual life without contraception in patients under 35 years of age and for 6 months in patients after 35 years of age or at the age of a man over 40 years of age;
  2. Even before the end of the above terms, if there are factors that reduce fertility. These factors include: a history of tubal pregnancies involving both fallopian tubes or one fallopian tube in combination with inflammatory diseases of the pelvic organs; ovarian resection; other operations on the pelvic organs or abdominal cavity; cases of amenorrhea; when the ovarian reserve is in a state close to exhaustion (after the age of 40, after radiation treatment or chemotherapy in young women, etc.).

controlled ovulation induction

After the diagnosis of infertility, the period of examination, conservative and surgical treatment without the use of assisted reproductive technologies should not exceed two years in patients under 35 years of age and 1 year in patients after 35 years of age.

Regardless of the cause and degree of damage to the reproductive system, the formation of infertility is due to the presence of the main or a combination of the main causes. These reasons include the following conditions:

  • oocyte maturation does not occur;
  • the fallopian tubes are impassable;
  • the endometrium is not ready for embryo implantation;
  • it is not enough for fertilization to receive sperm into the uterine cavity and further into the tubes (insufficient number of sperm in the ejaculate, violation of the properties of cervical mucus, etc.).

By the beginning of conservative infertility treatment, it is necessary to exclude a severe degree of male infertility factor and tubal infertility factor, the presence of which requires the use of assisted reproductive technologies.

If the duration of treatment already exceeds one year, you should not use methods with low efficiency (for example, the appointment of clomiphene citrate, physiotherapy, IUI-insemination without ovulation induction), but switch to methods with proven high efficiency (induction of ovulation with gonadotropins, insemination with ovulation induction, laparoscopy followed by ovulation induction or controlled ovarian stimulation).

These guidelines contain new information about the use of traditional ovulation inducers, such as clomiphene citrate, but are mainly aimed at teaching the use of modern effective direct ovulation inducers.

How dangerous is the IVF program

Today we will talk about the most exciting aspects of the IVF program and, based on scientific research in recent years, we will answer possible questions.

What is the danger of ovulation stimulation? Modern features

In the past years of the revival and the beginning of the use of controlled superovulation in the implementation of IVF programs, reproductologists used high doses of gonadotropins during stimulation, sought to get as many oocytes as possible, since it was believed that this increases the chances of fertilization and obtaining embryos. As they tried to get more cells, they also tried to transfer “more” embryos.

Now the approaches have changed categorically. Currently, it has been proven that the use of high doses of gonadotropins during controlled supervovulation does not increase the chances of fertilization, leads to rapid depletion of the ovaries, has a greater number of side effects. The ovarian response to stimulation after puncture is evaluated as follows: 0 oocytes – no response, 1-2 oocytes-poor response, 3-6 oocytes-a satisfactory response, more than 7 oocytes – a good response.

It is proved that the level of ovarian response does not affect the quality of embryos in the presence of mature oocytes. However, with a satisfactory and good response, it is possible to cryopreservate a larger number of embryos without forcing a woman to undergo the ovulation stimulation procedure several times.

IVF program

With a poor answer, the scheme of “accumulation” of embryos is currently used: several ovulation stimulations are performed with minimal doses of gonadotropins and 1-2 embryos are obtained from each such program, after which the “best” embryos are cryopreserved and only then the endometrium is prepared for embryo transfer. This scheme is beneficial for its gentle effect on the ovaries of a woman, it also contributes to the production of the most mature eggs and is used mainly in women with extremely low ovarian reserve (AMH level<1 ng/ml).

Ovarian hyperstimulation syndrome, what is it and how to avoid it?

Most women suffering from infertility have heard about ovarian hyperstimulation syndrome, the fear of this complication of IVF often pushes women away from the program. Ovarian hyperstimulation syndrome (OHSS) is a condition based on the reaction of the ovaries in response to the introduction of hormonal drugs (ovulation inducers), the doses of which exceed physiological values. This condition was first described in 1930 when using the serum of foaled mares.

Ovarian hyperstimulation syndrome is characterized by a fairly wide range of clinical manifestations: from minor changes in laboratory parameters to quite serious conditions requiring hospitalization.

The main reasons for its occurrence are high doses of hormonal drugs that are used to stimulate ovulation, and with a high level of activity of the hormone estradiol, which is produced in growing follicles, high levels of the hormone hCG. The main risk group for the formation of this syndrome are girls with a diagnosis of “Polycystic ovary syndrome”, since this group has a high follicular reserve and a large number of follicles “begins to grow” during induction.

Ovarian hyperstimulation syndrome is currently a well-studied syndrome, for this reason, reproductologists around the world are trying to stimulate the ovaries using minimal hormonal load, pursuing the main goal: to get the maximum number of mature and high-quality oocytes, to avoid ovarian hyperstimulation syndrome. All patients who are preparing for the IVF program undergo a thorough examination (according to order 107n of the Russian Federation), a reproductive doctor assesses all possible risks, preventive measures are taken in the presence of risk factors for OHSS.

Women with a high risk of the syndrome are recommended to carry out an IVF protocol followed by embryo cryopreservation and embryo transfer in another cycle.

IVF program” freezing ” of embryos

The cryopreservation method allows you to save embryos for a long time, so if the IVF attempt is unsuccessful, the “saved” embryos can be used in the future. In cases where the IVF program has been successful and the pregnancy has occurred, the remaining frozen embryos can be used in the future, when the couple decides to give birth to another child. An additional advantage of the method is to reduce the number of repeated ovarian stimulation and follicle puncture, which significantly reduces the drug load on the female body.

Drug therapy of diffuse mastopathy and PMS

According to the WHO definition (Geneva, 1984), mastopathy (fibrocystic disease, dyshormonal dysplasia of the mammary glands) is a dyshormonal hyperplastic process characterized by a wide range of proliferative and regressive changes in breast tissue with an abnormal ratio of epithelial and connective tissue components. Fibrocystic disease is very heterogeneous in its clinical, radiological and morphological manifestations. The etiology of the disease is also diverse. The occurrence of mastopathy is often associated with violations of the reproductive sphere of a woman, social and household problems, hormonal imbalance, various types of hepatopathies that lead to hormonal and metabolic disorders.

Clinically, fibrocystic disease is manifested primarily by mastalgia, varying in nature and degree of intensity. As a rule, pain in the mammary glands bothers the patient before menstruation or in the middle of the menstrual cycle. Often such complaints are accompanied by an increase in volume, swelling, swelling of the mammary glands. The tissues become heterogeneous, painful on palpation, seals form. When pressing on the nipples, discharge may appear.

Classifications of mastopathy

Despite the many proposed classifications of mastopathy, one of them does not fully reflect the full variety of morphological changes occurring in the mammary gland. In clinical practice, the classification proposed by N. I. Rozhkova (1993) is most often used, where the following forms of mastopathy are distinguished: diffuse mastopathy with a predominance of the glandular component (adenosis); diffuse fibrocystic mastopathy with a predominance of the fibrous component; diffuse fibrocystic mastopathy with a predominance of the cystic component; mixed diffuse fibrocystic mastopathy; sclerosing adenosis; nodular fibrocystic mastopathy.

According to the degree of severity of the detected changes, diffuse fibrocystic mastopathy (FCM) is divided into slightly, moderately and sharply expressed. According to the degree of proliferative activity of the epithelium, there are: mastopathy without proliferation (I degree); mastopathy with epithelial proliferation (II degree); mastopathy with atypical epithelial proliferation (III degree). Due to the presence of a wide range of clinical and histological manifestations, the treatment of diffuse mastopathy is very difficult and requires, first of all, the establishment of the main causes of the disease. Adequately selected therapy should be complex, long-term, taking into account the hormonal, metabolic characteristics of the patient’s body, concomitant diseases. According to modern concepts, the complex treatment program for diffuse mastopathy includes phytotherapy-collections of herbs of multidirectional action.

Treatment of mastopathy

One of the most effective means of treating mastopathy and premenstrual syndrome is the combined drug Mastodinone (manufacturer-the German company “Bionorica”). The main component of the drug is an extract of prutnyak fruit BN0 1095. In addition, it includes a basilisk-shaped stalk, an alpine violet, a bitter chestnut, a multicolored killer whale, a tiger lily. The use of ordinary prutnyak (synonym-Abraham’s tree; Lat. Vitex adpis castus) has a long history (the first description refers to the IV century BC). Vitex agnus castus is widely used in the treatment of gynecological diseases: menstrual cycle disorders, amenorrhea, luteal phase insufficiency, premenstrual syndrome. Since 1975, the extract of prutnyak fruits has been used in the form of the phytopreparation Mastodinon.

The main mechanism of action is a stimulating effect on the dopamine D2 receptors of the anterior pituitary lobe, which leads to a decrease in prolactin secretion. Hyperprolactinemia, which is not associated with pregnancy and lactation, has a direct stimulating effect on proliferative processes in peripheral target organs, which is realized by increasing the production of estrogens by the ovaries. The ability of prolactin to increase the content of estradiol receptors in the tissues of the mammary glands also plays a role. These mechanisms determine the development of the entire symptom complex characteristic of premenstrual syndrome and fibrocystic disease.

mastopathy

A decrease in the increased level of prolactin due to taking Mastodinone leads to a regression of pathological processes in the mammary glands and stops the cyclic pain syndrome in mastopathy or premenstrual syndrome. When the prolactin level is normalized, the rhythmic production and the ratio of gonadotropins are restored, the imbalance between estradiol and progesterone is eliminated, which contributes to the restoration of the menstrual cycle. The recommended regimen for taking Mastodinone is 30 drops (1 tablet) 2 times a day for 3 months without a break, regardless of the menstrual cycle. After that, you can take a break for 1-2 months, then resume taking the drug. Clinical improvement is noted after 4-6 weeks of use. Individual intolerance to the drug is extremely rare.

Unlike many dietary supplements advertised for the treatment of fibrocystic disease, the effectiveness of Mastodinone has been demonstrated in a number of scientific studies, the results of which have been published in domestic and foreign literature. The most satisfactory results were obtained in the group of patients with diffuse forms of mastopathy and premenstrual syndrome (n=1472). 1064 patients (72.3%) noted a significant improvement in well-being (a decrease in the density of breast tissue, a decrease or cessation of nipple discharge, normalization of the menstrual cycle, a decrease in headaches and abdominal pain), 397 women did not record changes in their condition and only 11 patients complained of increased symptoms.

Conclusion

Thus, the results of the conducted studies have shown the high effectiveness of Mastodinone and Cyclodynone in patients with benign diseases of the mammary glands and menstrual function disorders. It should be emphasized that the high effectiveness of the drugs in combination with a low frequency of adverse reactions makes them extremely attractive for wide use.

Female Bodybuilding and Steroids

Often, many women coming to the mirror are disappointed: sluggish, not knowing even the minimum load, muscles, accumulated fat, swollen thighs. And how do you want to look like a Greek goddess and catch admiring glances at yourself, and that men turn their necks when you pass by?! But how to do it? Female bodybuilding is the answer.

Female Bodybuilding

All is not lost! It’s time to do bodybuilding. Bodybuilding literally means building, the architecture of the body. There are few people left who would dispute the benefits of this sport. Medical science has proven that weight training is a magical panacea for the troubles that come with the years, from the destructive lifestyle that we lead. But the figures of many bodybuilders are embarrassing. It seems to people that such achievements are possible only as a result of hard, many hours of work, incompatible with the lifestyle they lead, or with taking some drugs (for example, clomid) that provide growth and relief of muscles. They are partly right. However, just one 40-minute workout a week can have a pronounced effect, even the usual morning 10-15-minute exercise brings tremendous benefits to the body and stagnant muscles. Well, if you want to look like a bodybuilder, you need to train like a bodybuilder. That is, according to a scientifically-based method of training with special sports nutrition, purposefully and stubbornly. You can make your body strong and beautiful by walking the beaten paths of champions, using the legendary techniques of famous bodybuilders.

A man who wants to be like the heroes of Hollywood action movies, who do not care about lifting a truck or dispelling clouds of enemies without straining, has to work hard for a long time in the gym. It is three times more difficult for a woman to become such an Amazon. For the fairer sex, a serious restructuring of the body is fraught with serious health problems.

According to the plan of nature, the number of cells that form muscles. It remains relatively constant throughout life. Muscle cells do not multiply, they can only increase in size. How many muscle cells a person is endowed with at birth will depend on how soon he will be able to turn a soft, loose tummy into a rubber-like press. The growth of muscle mass is impossible without the entry into the body of the main building material for the formation of contractile fibers-proteins.

The fat layer between the muscles and the skin does not give the muscles beauty, so a large amount of animal and vegetable fats, as well as carbohydrates contained in food, is not consumed by a real bodybuilder.

It is not difficult for men with a minimum amount of fat in the diet to live at all. The main thing is not to bring yourself to a complete ” degreasing”. It begins to dissolve its own fat, for example, which is located around the kidneys, supports them and is a good amortizer. The kidneys can move down, become ” wandering”, which is fraught with a lot of unpleasant sensations and, in addition, can lead a handsome man to the nephrology department. In women, adipose tissue also serves as a source for the construction of their own sex hormones – estrogens. We have two x-chromosomes and we are, of course, women, but, figuratively speaking, fat makes a woman actually a woman. The shape of the female breast, so adored by men,is due to adipose tissue.. That is why completely fat-free bodybuilders can not boast of beautiful, lush, soft breasts. However, now plastic surgery is on top with numerous mammoprostheses.

How to achieve the result?

Who among us has not dreamed of achieving the desired results as soon as possible? Still, there is no need to hurry. A well-chosen training program and a proper nutrition system allow a woman to get rid of excess fat from 2% monthly, until the goal of harmony and perfection of the body is achieved. After several months of working in the gym, a woman, going to the mirror, can find remarkable results that are already noticed by others: the stomach does not hang down, does not gather folds, the buttocks have tightened, become elastic, the treacherous breeches have significantly decreased in size, and the chest, which until recently was hanging sadly from the chest wall, suddenly begins to please the eye. At this stage, body building can be called a beautiful word fitness. Literally translated from English, this word means ” fitness”, and this term means the development of optimal physical abilities that allow “to withstand the hardships of modern life”. For some, fitness means a thin waist, for others-to squeeze out their own weight lying down, for others-just feeling good. And for a woman engaged in physical labor, the level of fitness will be different than the necessary level for a secretary-assistant, older people need a different program and level than young people.

What is important in fitness is not strength, endurance or fat content, but their combination. A prerequisite for fitness is the lack of bodybuilding massiveness. For a bodybuilder, muscle mass is everything! A fitness player with her beautiful, harmoniously developed body can not be disliked even by people who are far from sports. The main slogan of fitness is for beauty and femininity! Such results are achieved by special types of training aimed at women. At the same time, muscle strength increases, but the relief of the muscles remains smooth and soft. In addition, with the help of strength exercises, such vital qualities as endurance, speed, flexibility, dexterity are developed. Fitness has a positive effect on the cardiovascular system, normalizes the physical and mental state, which allows a person to live fully and successfully endure all the hardships of life presented in our turbulent time. Most are quite satisfied with the transformed body, which has not lost a single drop of femininity. They stop and maintain the achieved state with short, but regular workouts.

Many women think that training with weights will immediately lead to the growth of huge muscles and loss of femininity. But this is a misconception!

Imagine that all women who train with loads have large muscles. Then why do we not see such girls in athletic halls? It’s very simple. In order to develop such muscles, a woman needs: genetic data, intensive long-term training, it is desirable to have an increased level of testosterone (male hormone). Most of the pumped-up women are elite professional female bodybuilding, athletes engaged in light and weightlifting, who have been training for years to achieve such a result. Of course, there are also those who additionally take androgens for an unnatural increase in muscle volume. It is very difficult for an ordinary woman to develop really big muscles. But many people do not understand this and avoid bodybuilding. And big muscles in the mass consciousness make a woman less of a woman. All over the world, the strength, musculature and masculinization of a woman seems at best a strange phenomenon, and at worst it causes dislike and disgust. And it is quite obvious that if professional bodybuilders become more and more like guys with implanted breasts, female bodybuilding will die.

Female bodybuilding harm from testosterone

But some women do not stop at the achieved harmony and go further than female bodybuilding-fitness. What makes women increase the load and bring the body to a state of total masculinization, sacrificing their own health? Scientists have conducted research and noted that a mental illness called “muscle dysmorphia”is common among bodybuilders. This disease is inherent in both women and men. In this condition, a person is constantly worried: have his muscles disappeared somewhere? And did the torso look worse than 2-3 hours ago? Such thoughts make him / her not leave the gym at all or turn his / her entire home into a gym. The constant self-admiration of the reflection in the mirror does not suit the worried bodybuilder at all.

female bodybuilding

Strength exercises more than five times a week are a serious danger for women. Ardent bodybuilding fans often suffer from eating disorders, a distorted perception of their own body and complications caused by the excessive use of steroid hormones. Today, the truth of female bodybuilding is that female bodybuilders are sitting on the needle just like men. This is an easier way to build muscle. After all, without this, nothing shines at tournaments. But hormones in the bodies and souls of women cause more severe and irreversible symptoms of rejuvenation. Muscles by themselves do not take away a woman’s femininity. Femininity is taken away by steroids!

As steroids penetrated into female bodybuilding, public interest in it fell. Today, creatures whose gender is difficult to determine, if at all possible, are coming to the podium. Except for Linda Murray and Sue Price, who somehow managed to survive in this battle for masculinity, the ranks of participants were terrifying. The participants do not discuss the topic of “chemistry”, and go into a deaf refusal with such questions. Since this topic is quite painful for them, and no one will ever understand what happens to a woman’s brain when she gradually turns into a man.

Testosterone causes significant harm to a woman’s health. Normally, they produce this sex hormone in a small amount. In minidoses, getting into the blood, the hormone stimulates muscle growth, improves regenerative processes in tissues, reduces the phenomena of osteoporosis, accelerates metabolism, and does not have a bad effect on the body. But everything is good in moderation, however, for female athletes, the abuse of steroid hormones is typical. Horse doses of synthetic analogues of testosterone cause suppression of the production of female sex hormones, moreover, they have effects that do not improve the appearance of a woman at all. Among the numerous side effects:

  • skin defects, a huge number of red pimples appear on the face, scientifically called acne, the skin becomes drier, pimply, with laces of veins on swinging muscles;
  • hirsutism or increased hair growth on the body and on the face is an irreversible effect of steroids. Hair breaks out on the chin, on the upper lip, arms, legs, and even on the chest. And in the perineum, they grow just crazy! Depilation will have to be done, almost every day, for the rest of your life. Hair loss and deterioration of the structure of the hair on the head;
  • stretching of the abdominal wall: steroids irritate the intestines, as a result, constipation, accumulation of gas, liquids begin. The stomach sticks out forward, and to hide it, you need to constantly strain the press. Pathological weakening of the internal corset, stretching of the abdominal wall, training with a load lead to rectal prolapse and hemorrhoids;
  • a sharp increase in the smell of sweat: testosterone affects the sweat glands, the composition changes and the secretion of sweat increases, the smell becomes unpleasant, striking, like a man after a long active workout. Aggressiveness and psychological instability: testosterone makes a bodybuilder simply unmanageable. She will yell, make a row, wave her hands about and without;
  • sexual aggression and increased sexual activity: a bodybuilder wants complete animal satisfaction immediately, right where physical desire has rolled over her, and this is several or more times a day. And it will be quite burdensome for a partner to perform male duties several times a day. And it is very unusual and many people become uncomfortable if the partner expresses her emotions in a male baritone (and if the neighbors are listening ?!);
  • the coarsening of the voice, the growth of cartilage (an overgrown nose) is an irreversible process;
  • clitoral enlargement (irreversible process): to an unnatural size, and in a state of arousal, the clitoris increases even more, almost like a small penis during an erection. To see a woman like this is not a sight for faint-hearted men! Bodybuilders say that thanks to such an acquisition, they experience a deeper orgasm, and sometimes the sensitivity increases so much that climbing the stairs in tight jeans becomes a problem due to unbearable excitement. And this is forever;
  • increased vaginal secretion: vaginal discharge, which becomes abundant only at the moment of the highest sexual arousal, in “steroid patients’ The changes of bodybuilders occur continuously, creating a lot of problems. This is not a disease or an infection, but simply a physiological disorder that stops with the cessation of taking steroidoad;
  • absence of menstruation;
  • ovarian sclerocystic disease: with subsequent infertility. The ovaries, as if hiding from male hormones, are covered with a dense capsule;
  • liver damage, increased blood pressure and other disorders of the cardiovascular system.

Conclusion

We found out why masculinization occurs, why large muscles grow in a short time and saw the problem of taking steroids by a woman even deeper. If you accept it, then stop before it’s too late!

Female bodybuilding is a wonderful and very useful sport, the purpose of which is to make your body worthy of your spirit. This is one of the ways to keep yourself in good physical shape. And you can choose how strong, beautiful, fit you want to become. Come up with your own ideal and strive for it, and “healthy” bodybuilding is a great ally for you in this!