COVID-19 and the ability to conceive a child

There is still more scientific data on the impact of dangerous microflora on the ability to reproduce offspring relative to men. Cases of testicular inflammation of viral genesis have been recorded. Also, SARS-CoV-2 was detected in male seminal fluid. The ACE 2 protein, which promotes the penetration of the virus to the human cell, is found in large quantities in the testes.

Among women, the age category from 37 years old is the most negatively affected by microorganisms. Factors contributing to damage to the reproductive organs are the severity of the disease and excess body weight. Overweight patients after a severe form of Covid have a 5-fold increased risk of a decrease in the supply of eggs, compared with young girls who have been ill easily or asymptomatically.

Read also: Coronavirus and pregnancy.

The growth of gynecological diseases during the pandemic has not yet been observed. Their structure remains stable. In the leading positions — inflammation of the pelvic organs (per 100,000 – 3,000 cases). Menstrual cycle failures are in second place (per 100,000 – 1300). There are 225 women with infertility per 100 thousand. These are approximate figures, since many girls take birth control pills, others do not live a sexual life, and others are not going to become mothers in the near future. These categories (in the majority) do not know the state of their own fertility. For sure, many of them have a violation of reproductive function.

IVF and coronavirus

During the pandemic period, infertile patients were much less likely to seek medical help due to sanitary and epidemiological restrictions and self-isolation. In 2020, outpatient services were not fully available. From February 2020 to July, assisted reproductive programs were suspended. According to statistics, about 50 thousand infertile couples did not use ART during this six-month period. At the moment there are no restrictions, the procedures are carried out as planned and the indicators have leveled off.

Vaccination during pregnancy

In the USA, 14 thousand women were vaccinated during gestation. Information on 827 vaccinated pregnant women has been published. The following conclusions are made: the complications are the same and occur with the same frequency as in the unvaccinated. The number of spontaneous abortions, premature births, fetal development disorders and other complications are not increased, and do not differ with the general population frequency of pathological changes.

Clomid and pregnancy

Clomid and pregnancy: It is very important to remember that each patient has her own, only her inherent reaction to those drugs (for example, clomiphene) that are injected into her body and each subsequent treatment cycle will be different from the previous one.

This means that in reality your reaction not only can and will differ from the reaction of other patients to the same drugs, but also that for each subsequent treatment cycle your body can give a reaction completely different from the previous one. Therefore, it should be understood that your examination, treatment and its results may not be the same as in other patients. We kindly ask you not to compare the results of your examination and treatment with the results of other patients.

Of course, you can find a lot in common with them, but take into account that the use of assisted reproductive technologies (ART) is a purely personal matter for each person and most patients experience great inconvenience when discussing personal problems in public. The information presented here will help you consciously go through the treatment cycle. If you have any questions, be sure to ask your doctor.

Clomid and pregnancy: recommendations before starting treatment

If you have come to an agreement in your family and with your doctor, you need to clarify the specific treatment program. You will sign (wife and husband) a statement of commitment about your intention to undergo treatment using ART techniques and give informed consent to this. Carefully read and understand all the provisions of the statement, clarify what you do not quite understand.

In addition, you will be given to read, understand and sign a financial contract and a checklist, which will indicate exactly the technique that will be used in this treatment cycle. Together with your doctor and nurse, you will review the certificates you have collected, the results of the examination, and other documents and decide on the start of an agreed treatment program.

What should be done to increase the chances of success?

clomid and pregnancy

For women:

  1. If you are prescribed some medications (clomid) by another doctor, you need to inform your doctor before starting the infertility treatment program.
  2. Cancel the use of any alcoholic beverages and do not smoke tobacco.
  3. Limit the use of coffee and caffeinated saturated beverages as much as possible (no more than 2 cups per day).
  4. Do not change the diet during the implementation of ART programs and do not carry out any dietary nutrition for weight loss.
  5. 3-4 days before the scheduled puncture of the follicles, as well as for the transfer of embryos into the uterus of the expectant mother and for tests to establish pregnancy, we strongly advise you to refrain from sexual intercourse and from excessive physical exertion.
  6. A little physical activity will not hurt until, as a result of taking ovulation inducers, a feeling of discomfort in the lower abdomen appears.
  7. For the duration of the ART treatment program, we strongly advise you to refrain from a hot bath, not to go to baths and saunas.

For men:

  1. In any painful condition, especially with an increase in body temperature (this is very important in the conditions of the spread of coronavirus), you should consult a doctor. It should be remembered that medications can negatively affect the quality of sperm.
  2. Two to three months before the start of ART treatment programs, you should use the shower and avoid going to the bath or sauna. High temperature negatively affects the quality of sperm. Like the Ministry of Health, we warn that taking medications, alcohol and smoking tobacco adversely affect the quality of sperm and should be excluded from use before and during ART programs.
  3. In the presence of a herpes infection or symptoms of any disease (malaise, rapid unmotivated fatigue), a married couple can be removed from the ART program.
  4. Within two to three months before the start of the ART program, we recommend reducing the intensity of sports, try to avoid overwork altogether.
  5. Refrain from wearing tight underwear.
  6. Refrain from sexual intercourse three to four days before the ultrasound, but no more than 7 days. Follow the doctor’s advice on behavior during the ART treatment cycle.
  7. Try to find out all the questions from specialists. Remember that the advice of friends is not always really friendly, and self-medication is unacceptable.

The phrase clomid and pregnancy is not a panacea. Remember what we wrote in the first paragraph of our article. Each organism is unique, if clomid helped your friend, it does not mean that it will help you.

The effect of clomiphene on sexual desire

Clomiphene on sexual desire: Sexual desire (libido) is a complex of desires and related experiences, which is based on biological instincts aimed at reproducing life. It includes the desire for sexual intimacy, the severity and direction of which are determined by the genetic set of chromosomes, the diencephalic part of the brain, the development of the endocrine glands and the formation of conditioned reflex complexes under the influence of individual psychosocial experience.

Clomiphene on sexual desire

Libido level is not a permanent condition. The level of sexual desire depends on many current factors.

There is a naked woman nearby – the libido level is high – this is normal, but if it is low – it is not normal.

There is a naked woman next to you and she is your sister – the libido level is low – this is normal, but if it is high – it is not normal.

Although the situations are very similar, but social norms and your upbringing completely kill your libido, although tens of thousands of years ago this would have been the norm, and the situation could have been the opposite.

There is a naked woman next to you, she is your wife and she wants sexual intercourse – the libido level is high – this is normal, but at the same time, if you were fired from work, your car broke down, a disease was diagnosed, which caused serious stress and anxiety – the lack of libido at the moment is also the norm.

clomiphene on sexual desire

In this case, stress and anxiety completely interrupt libido.

Also, the norm may be a more elevated libido at the beginning of a relationship with a new partner, and a decrease in sexual attraction to this partner after 20 years of relationships is also the norm. Lack of sexual attraction to a partner is most likely not the norm, but a decrease is the norm.

A decrease in libido with age is also the norm, I don’t think that at 50-60 years old, wanting the number of sexual acts as at 16-20 years old will be the normal functioning of the psyche. A higher libido in youth is the norm, a drop with age is also the norm.

The main thing to understand is that testosterone is not the only factor affecting sexual desire and its strength. And an increase in testosterone in 100% of cases will lead to an increase in libido.

From libido theory to clomiphene

Consider a number of studies:

The first sufficiently extensive study, with a large number of people and long-term use of clomiphene. The general conclusion is that taking clomiphene does not cause any special side effects.

Results – a total of 12318 men took clomiphene and represented the main study group, whose average age was 37.8 years. In men taking this medicine, there was no increased risk of side effects of clomiphene.

The second study compared the intake of clomiphene and HRT and the effect on symptoms. Studies have shown that HRT is more effective due to a stronger increase in testosterone. At the same time, clomiphene is the preferred method if necessary to preserve fertility. But, those taking clomiphene noted an adverse effect on libido. This is the only study that turned out to be found where a negative effect on libido was noted.

Clomiphene on sexual desire conclusions. Both TC and GC are effective drugs for the treatment of hypogonadism; however, our study shows that TC more effectively increases the level of testosterone in the blood serum and improves the symptoms of hypogonadism. K remains a viable treatment method for men with hypogonadism, but its adverse effect on libido requires further study

When asked about the goals and objectives that a person wants to implement with testosterone-boosting therapy, the top looks like this:

  1. Improvement of general well-being and reduction of general fatigue (chronic fatigue, sleep problems, joint pain.
  2. Stabilization of the psycho-emotional state (anxiety, anxiety, depression).
  3. Increasing the amount of muscle mass. Many still consider testosterone-boosting therapy as an alternative to the course. Although this is not true.
  4. Improved erection.
  5. Improved libido.

Pregnancy after ovulation stimulation

Pregnancy after ovulation stimulation: A necessary condition for the onset of pregnancy is the presence of ovulation. If this physiological process is absent or incomplete, then we can talk about infertility.

However, in the modern world there are ways to deal with this unpleasant phenomenon, and an increasing number of women manage to get pregnant after ovulation stimulation.

Problems with ovulation have become a fairly common cause of infertility, but fortunately modern methods of treatment allow many women who encounter them to become pregnant. Reproductive medicine offers patients to use medications to stimulate natural processes. Pregnancy after ovulation stimulation is possible for women with healthy eggs, which for some reason do not mature in the body on their own. This method is also effective for patients with polycystic fibrosis. However, the procedure for obstruction of the fallopian tubes can cause ectopic pregnancy, so it is prescribed only after laparoscopy. It is pointless to carry out such therapy with the male factor of infertility. Contraindications to ovulation after stimulation also include:

In any case, only a doctor can make a decision about ovulation stimulation!

Diagnosis before starting treatment

Before you start taking medications, you need to undergo a comprehensive examination and establish an accurate diagnosis. A woman needs to take blood tests, do an ultrasound of the mammary glands, check the patency of the fallopian tubes. The last point is especially important for patients with abortions, curettage and pelvic inflammatory processes in the anamnesis. This examination is mandatory for those who have used an intrauterine device for contraception. Immediately before stimulation, a woman’s hormonal background is examined.

Stimulation procedure

Ovulation after stimulation occurs against the background of taking drugs based on gonadotropins (Clostilbegyt, etc.). They are injected into a woman by injections into a muscle or subcutaneously. The doctor determines the doses and duration of use of medicines. As a result of the use of ovulation inducers, the patient’s ovaries produce one or more eggs ready for fertilization. The more they turned out, the higher the chances of getting pregnant. During the stimulation process, a woman is obliged to continuously monitor the basal temperature, hormone levels, and the degree of egg maturity. To do this, she has to regularly take blood tests and undergo ultrasound diagnostics.

A man regularly does a spermogram. When the doctor sees that ovulation has occurred, a woman has a chance to get pregnant naturally or with the help of IVF. In the first case, several eggs will be needed, in the second one or two are enough. The control of the process by the doctor increases the chances of success, since the maximum probability of pregnancy falls on the day of ovulation, and it is quite difficult to determine this moment independently.

Pregnancy after stimulation ovulation

If conception occurs with the help of special treatment, the risk of termination of pregnancy increases markedly, especially if we are talking about early terms (up to 4-6 weeks). Another danger is the development of fetal hypoxia, gestosis and gestation of two or more fetuses. Pregnancy with ovulation stimulation requires the expectant mother to regularly take blood tests for hormone levels and undergo ultrasound. In addition, quite often after the use of the above drugs, ovarian hyperstimulation syndrome occurs, which can have a bad effect on the course of pregnancy. Therefore, everyone who became pregnant after ovulation stimulation needs to undergo a medical examination once a week. The success of the procedure is influenced by the age of the woman, the causes and duration of infertility. The first attempt to get pregnant on drugs gives a positive result to only 10-15% of patients. On the other hand, pregnancy after ovulation stimulation is quite real and it is worth striving for.

Clostilbegyt – stimulation ovulation

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.

clostilbegyt

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.

Questions that few people ask before IVF

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.

IVF questions

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.

Reasons for the lack of ovulation

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.

lack of ovulation

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.

Lack of ovulation (anovulatory cycle)

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.

anovulatory cycle

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.

Clomiphene: Characteristics of the substance

Characteristic of the substance Clomiphene is a white or white crystalline powder with a cream tint. Slightly soluble in water, moderately soluble in alcohol.

Pharmacological action is antiestrogenic. Binds estrogen receptors in the hypothalamus and ovaries. When ingested, it is well absorbed from the gastrointestinal tract. It is metabolized in the liver. It is excreted with bile, undergoes enterohepatic recirculation. It is excreted from the body with feces. T1/2 is 5-7 days. In small doses, it enhances the secretion of gonadotropins, stimulates ovulation. With a low content of endogenous estrogens in the body, it has a moderate estrogenic effect, with a high level — antiestrogenic. By reducing the level of circulating estrogens, it promotes the secretion of gonadotropins. In large doses, it inhibits the secretion of gonadotropins. It does not have gestagenic and androgenic activity.

Application of the substance Clomiphene

Anovulatory infertility (ovulation induction), dysfunctional uterine bleeding, amenorrhea (dysgonadotropic form, secondary, postcontractive), galactorrhea (against the background of pituitary tumor), polycystic ovaries (Stein—Leventhal syndrome), Chiari-Frommel syndrome, androgen deficiency, oligospermia, for the diagnosis of disorders of the gonadotropic function of the pituitary gland.

Anovulatory infertility (ovulation induction); amenorrhea (dysgonadotropic form), secondary amenorrhea, post-contraceptive amenorrhea; Stein-Leventhal syndrome (polycystic ovary syndrome); oligomenorrhea; galactorrhea (on the background of a pituitary tumor); Chiari-Frommel syndrome (syndrome of prolonged postpartum amenorrhea-galactorrhea); androgen deficiency; in men – oligospermia.

clomiphene

Contraindications

Hypersensitivity, severe hepatic and/or renal insufficiency, uterine bleeding of unknown etiology, ovarian cyst, tumor or insufficiency of pituitary function, pregnancy (including suspicion of it).

Hypersensitivity to clomiphene; pregnancy, lactation (breastfeeding); ovarian cyst (with the exception of polycystic ovarian syndrome); tumor or hypofunction of the pituitary gland; thyroid or adrenal dysfunction; metrorrhagia of unclear etiology; long-term or recently developed visual disturbances; neoplasms of the genitals; endometriosis; ovarian insufficiency against hyperprolactinemia.

Special instructions

It is recommended to check liver function before using clomiphene.

Before using Clomid, it is necessary to conduct a thorough gynecological examination. The use of clomiphene is indicated in cases when the total level of gonadotropin in the urine is below the lower limit of the norm or at the normal level, ovarian palpation does not reveal deviations from the norm, and the functions of the thyroid gland and adrenal glands correspond to the norm.

In the absence of egg maturation, all other possible causes of infertility should be excluded or treated before the use of clomiphene. If an increase in the ovaries or their cystic transformation is detected, the use of clomiphene is not allowed until the ovaries return to normal size. In the future, the dose or duration of treatment should be reduced.

In the course of treatment, constant supervision of a gynecologist is necessary, ovarian function should be monitored, vaginal examinations should be performed, and the phenomenon of the “pupil” should be observed. Often during the course of treatment it is difficult to determine the moment of ovulation, and there is also often a deficiency of the corpus luteum. Therefore, after conception, it is recommended to start preventive administration of progesterone.

Effectiveness of clomid

Effectiveness of clomid: Arrighi’s data on the low efficacy of clomiphene in patients with an inferior luteal phase confirm the good results we have obtained in the treatment of this pathology with synthetic progestins. So, according to Townsend, clomiphene will give effect only with a daily excretion of estrogens of at least 10 mcg /day. According to other authors, ovulation stimulation with clomiphene is possible only in patients with estrogen excretion of at least 20 mcg per day.

There are indications of low efficacy of clomiphene in patients with initial high gonadotropin secretion. Obviously, this applies to patients whose ovarian tissue is unable to respond to stimulation with gonadotropins and clomiphene.

A summary analysis of the data on the use of clomiphene in 6714 patients with anovulation, conducted by Macgregor, showed that ovulation appears in 70%, and pregnancy occurs only in 32.7% of women. Such a discrepancy between the frequency of ovulation and the onset of pregnancy is usually explained by the appearance of cyclic secretion of LH at an inappropriate time, resulting in premature luteinization of follicles without full ovulation.

Purpose and effectiveness of clomid

The administration of clomiphene in patients with impaired gonadotropin secretion revealed its low effectiveness compared to gonadotropins. In addition, it should be noted that every 5th woman with the onset of pregnancy after the use of clomiphene has an interruption in the second trimester (18.5%).

Our own experience of using clomiphene in 51 patients (in the presence of anovulation in 22 and an incomplete luteal phase in 29) showed that ovulation occurred in almost all women, and pregnancy occurred only in 18 of 51, i.e. in every third patient.

effectiveness of clomid

Effect

At the same time, the best effect was achieved in patients with anovulation. Ovulation was confirmed by an increase in the excretion of total estrogens by 2-3 times, and pregnanediol by 3 times. In most patients, 10-12 days after the end of taking clomiphene, the excretion of estrogens increases to 50-70 mcg / day and ovulation occurs, followed by an increase in basal temperature and the excretion of pregnanediol. If pregnancy has not occurred, then a menstrual-like reaction occurs 10-12 days after the basal temperature rises.

The effectiveness of clomid (treatment with clomiphene) in patients with estrogen excretion below 10 mcg / day was insignificant. Only 1 out of 8 patients with prolonged amenorrhea became pregnant. The relatively low effectiveness of treatment with clomiphene in patients with an inferior luteal phase was also noted.