Category: Health

Ovulation stimulation drugs that help to get pregnant are divided into three main types: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) preparations, HCG preparations and progesterone preparations.

To get pregnant, you need to fulfill three basic conditions:

1. the woman has ovulated;
2. the sperm fertilized the egg;
3. the embryo is securely fixed in the uterus.

Accordingly:

1. drugs that enhance the production of FSH and LH, which help to get pregnant, stimulate ovulation — the growth of follicles on the ovaries;
2. HCG helps the largest follicle to stay large enough and release an egg, which the sperm should fertilize;
3. progesterone prepares the inner layer of the uterus to secure the embryo and helps to carry the fetus.

A little theory: the mechanism of ovulation

Ovulation is the release of a mature egg from the ovary. Then the egg is sent through the fallopian tubes into the uterine cavity. This happens, as a rule, in the middle of the cycle, that is, on the 14th-15th day after the onset of menstrual bleeding. Women with a regular cycle, most likely, do not ask the question “Will I be able to get pregnant?”. With a regular cycle, ovulation usually takes place regularly.

If you come to the doctor with the question “Why can’t I get pregnant” or the complaint “I can’t get pregnant for a year“, then most likely you do not ovulate. Women cannot get pregnant without ovulation.

If you are interested in the question “Why can’t I get pregnant?“, you can do an ovulation test. You can buy it at the pharmacy. Consult a doctor if there is no ovulation for several consecutive cycles.

Ovulation may not occur for various reasons: due to hormonal failures, inflammation of the pelvic organs, and so on. If you have not been able to get pregnant for a year because ovulation does not occur, the doctor may prescribe injections and pills that help to get pregnant — stimulating it.

Drugs for ovulation stimulation: Who is shown?

If the question “Why can’t I get pregnant?” is relevant to you, then you need to undergo a checkup. It’s good if your spouse does the same — it would help to establish the cause of infertility.

Ovulation stimulation should be recommended by a doctor after a series of examinations that will give accurate data on the cause of problems with self-conception. The doctor prescribes drugs to stimulate ovulation in cases where:

• The patient had a rare maturation of the egg and its exit from the ovaries;
• The couple has been trying to get pregnant for more than a year to no avail;
• Spouses older than 35-40 years do not get pregnant for 6 months.

At the same time, ovulation stimulation is prohibited in the following cases:

• Partner infertility;
• The presence of inflammation of the appendages, with adnexitis;
• With pathologies of the uterus;
• In case of poor patency of the fallopian tubes.

FSH and LH preparations. The goal is ovulation

Under the action of FSH, follicles begin to grow on the ovary — “sacs” on the surface of the ovary, in which one egg cell matures. To stimulate the growth of follicles, such drugs are most often prescribed to help get pregnant:

• Clomid;
• Fertomid;
• Drugs that contain Clomiphene;

Drugs that help to get pregnant are selected individually, depending on the results of tests and ultrasound examination. In this article we describe the most famous, but not all existing drugs.

Clomiphene: mechanism of action

Clomiphene belongs to the group of nonsteroidal antiestrogenic drugs that stimulate ovulation. The mechanism of action of this drug is based on the activation of the synthesis of gonadotropins in the pituitary gland: FSH (follicle-stimulating), LH (luteinizing) and prolactin.

The effect of clomiphene directly depends on its dosage: the larger it is, the more gonadotropin production is suppressed, and vice versa, small doses of the drug enhance the formation of tropic hormones and promote ovulation. In addition, it is worth noting that the mechanism of action of clomiphene is affected by the concentration of estrogens in the blood: with small estrogen levels, it causes moderate estrogenic effect, and with elevated values leads to an antiestrogenic effect. At the same time, it does not affect the gestagenic and androgenic activity in any way.

Nowadays, the drug is widely used in gynecology as part of infertility therapy, because after its absorption, the processes of follicle maturation are activated and accelerated. Clomiphene is available in the form of flat tablets of grayish-white color. Its active ingredient is clomiphene citrate (Klostylbegit), in an amount of 50 mg per tablet. It is absorbed very quickly in the digestive tract after ingestion. The processes of disintegration of the drug occur in the liver, and the metabolites are completely excreted together with bile within 10-14 days.

Klostylbegit is often prescribed for IVF (in vitro fertilization) to stimulate the formation of eggs. There are cases when specialists do not wait for the rupture of the follicle, but immediately punctuate mature female germ cells for the next stage of IVF.

Indications and contraindications

The main purpose of taking klostilbegit (Clomiphene) is to stimulate ovulation, which is carried out in the following situations:

• Anovulatory cycles;
• Amenorrhea of various genesis or oligomenorrhea;
• Polycystic Ovary syndrome (PCOS);
• Pituitary tumors that cause galactorrhea;
• Prolonged postpartum amenorrhea and galactorrhea caused by various pathological processes, for example, Chiari-Frommel syndrome;
• Androgen deficiency.

Klostylbegit is prescribed not only for women, but also for men, since this drug has a positive effect on the quality of sperm, especially with oligospermia (a decrease in the number of sperm in the ejaculate).

But this drug can cause adverse reactions from other organs and systems, so it is contraindicated in renal and hepatic insufficiency, neoplasms of the reproductive system and pituitary gland, ovarian cysts, renal and hepatic insufficiency. It should not be used with changes in the functionality of the adrenal glands and thyroid gland, hypofunction of the pituitary gland, uterine bleeding of unclear etiology, visual and metabolic disorders. It is also not recommended to use klostylbegit during pregnancy and lactation, with hypersensitivity to the components of the drug.

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: 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?

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.

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:

• ovarian inflammation
• hormonal disorders
• age restrictions
• taking specific medications

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

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

Indications for the use of Clostilbegyt

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

Pros and cons of the drug

The main advantages of using clostilbegyt to achieve pregnancy are:

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

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

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

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

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

Clostilbegyt in infertility

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

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

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

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

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

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

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

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

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

Are there complications after IVF?

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

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

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

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

Is it true that repeated IVF attempts can provoke cancer?

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

What is the difference between IVF and hatching?

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

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

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

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

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

How to prepare for a visit to a reproductologist?

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

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

Physiological and pathological factors of lack of ovulation

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

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

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

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

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

Reasons for the lack of ovulation

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

The presence of diseases

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

Discontinuation of hormonal medications

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

Body weight change

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

Increased physical activity

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

Change of situation

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

Menopause

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

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

Methods for diagnosing the lack of ovulation

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

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

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

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

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

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