Category: Ovulation

Preparations for stimulating ovulation. Injections and pills to help get pregnant.

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

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

Respectively:

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 big enough to release an egg for a sperm to fertilize;
3. progesterone prepares the inner layer of the uterus to secure the embryo and helps to carry the fetus.

Who needs preparations for stimulating ovulation

If the question “Why can’t I get pregnant?” is relevant for you, then you need to undergo an examination. Well, 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 independent conception. The doctor prescribes drugs to stimulate ovulation in cases where:

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

In this case, stimulation of ovulation is prohibited in the following cases:

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

Drugs that help get pregnant, such as Clomid, are selected individually, depending on the results of tests and ultrasound examinations.

Frequently Asked Questions Related to Getting Pregnant

Can I get pregnant with PCOS?

The chance of getting pregnant with PCOS is very low. The greater the number and size of cysts, the less chance of conceiving a child.

Can I get pregnant with uterine fibroids?

The presence of fibroids significantly reduces the likelihood of pregnancy. The larger the diameter of the nodes, the less chance of pregnancy.

Can I get pregnant with endometriosis?

The probability of conceiving a baby with a diagnosis of endometriosis is, but very small. Severe stages of endometriosis can cause infertility.

Will I be able to get pregnant in the future if my first pregnancy ended in an abortion?

Doctors do not recommend ending the first pregnancy with a surgical abortion – the likelihood of infertility in this case is high. However, this is not the rule: some women safely bear children even after several abortions.

How to use prescribed preparations for stimulating ovulation

Drug regimens depend on the stimulation protocol, so you must strictly follow the doctor’s recommendations. Most drugs are administered intramuscularly or subcutaneously. Many of them have their own characteristics regarding the use and storage, and they are associated not only with the drug itself, but also with the form of release proposed by the manufacturer. In this regard, we advise you to make the first injection in our treatment room, where the nurse will tell you, and most importantly, show you how to properly administer a particular drug. We categorically do not recommend making injections according to the description on the Internet – the price of an error may be too high.

After the first menstruation, a cycle is established in the female body, which on average lasts about 28 days.

The cycle of ovulation and menstruation is part of the life of any woman of reproductive age. Normally, it can last from 21 to 35 days, and all the processes that occur during this period in a woman’s body are conditionally divided into several phases.

Menstrual phase. Period lasting from 3 to 6 days – bleeding from the uterus. At this time, rejection of the mucous membrane (endometrium) occurs. When pregnancy occurs, a fertilized egg is attached to the endometrium.

Follicular phase. It starts at the same time as menstruation, but lasts a little longer – on average, 14 days. At this time, the follicle matures in the ovaries, in which, in turn, a new egg will mature. The restoration of the endometrium in the uterus also begins.

Ovulatory phase. This period lasts about three days and during this time the follicle ruptures – an egg ready for fertilization comes out of it. This process is called ovulation and can cause mild pain in the lower abdomen.

Luteal phase. Duration – from 11 to 16 days. At this time, there is an active production of hormones (estrogen and progesterone), which prepare the body for pregnancy. During this phase, there is often a phenomenon such as PMS – premenstrual syndrome.

PMS is a complex of symptoms that are associated with changes in the hormonal background of a woman. For example, they include: swelling of the mammary glands, pain in the lower abdomen, mood changes and increased appetite.

Hormones and menstruation

The main hormones during menstruation can be called follicle-stimulating and luteinizing. Both of them provide the production of progesterone and estrogen. These active substances play an extremely important role in a woman’s body, so if you have menstrual irregularities or suspected pathology of the reproductive system, you should take an analysis for hormones. It allows you to identify uterine fibroids, polycystic ovaries and even infertility.

For any difficulties with conception, as a rule, the gynecologist refers the patient to the study of hormones. For diagnosis, it is necessary to know their “healthy” concentration at different segments of the cycle – based on these data and test results, the doctor can make a diagnosis and prescribe a specific therapy.

Hormones during the menstrual phase.

Analyzes are given on the 3-5th day from the onset of menstrual bleeding

• Follicle-stimulating FSH;
• luteinizing hormone LH;
• free testosterone;
• estradiol;
• dehydroepiandrosterone sulfate;
• prolactin;
• androstenedione;
• sex hormone binding protein;
• thyroid hormones;

Hormones in the luteal phase.

Analyzes are given on the 20-22nd day of the menstrual cycle.

• prolactin;
• prohysterone;

You also need to do an ultrasound of the pelvic organs on the 5-7th day of the menstrual cycle.

Folliculometry 3-4 times during 1 menstrual cycle.

The path to conceiving a child can be difficult and require the use of assisted reproductive technologies . In order for IVF to be successful, it is necessary to obtain several eggs. With natural ovulation, one, rarely two follicles ripen. And superovulation is a process when several mature in the ovary at the same time. It is created in the protocols of assisted reproductive technologies with the help of medicines. After receiving the eggs, they are fertilized and the embryos are transferred to the uterus.

Why do we need superovulation?

In in vitro fertilization, there is an IVF-EC protocol, or IVF in a natural (natural) cycle, when an egg is removed for fertilization during normal ovulation. This option is shown with a reduced ovarian reserve, when the number of immature follicles ends.

Indications for IVF-EC are also considered thrombophilia, antiphospholipid syndrome, habitual miscarriage, a history of oncopathology, contraindications to hormonal stimulation or poor quality of oocytes in response to it.

In IVF-EC, the frequency of pregnancy after embryo transfer is significantly lower, which is due both to the initial health conditions of the patients and to the peculiarity of the procedure – there is no possibility to choose an oocyte.

At the age of 40, according to world research, IVF EC is successful in 3-6% of cases, under 39 years of age, indicators vary in the spectrum of 11-53%.

Superovulation (ovarian stimulation protocol) allows you to achieve success much faster. With this phenomenon, 8-14 follicles mature in the ovary. And it’s not so much: some of them will be empty, some of them will be of poor quality. On average, 5-6 of the 10 follicles obtained during superovulation are selected for fertilization. The more oocytes, the higher the probability of success.

How is it stimulated?

To stimulate the maturation of a dozen follicles at once, hormonal drugs are used. They temporarily suppress their own hormones – luteinizing and follicle–stimulating (LH and FSH) and artificially stimulate the growth and maturation of follicles in the ovaries – with almost the same hormones created with the help of genetic engineering. Why do they do this?

The process of suppressing the production of the patient’s own hormones is necessary to control ovulation, otherwise there will be no eggs in part of the follicles at the puncture stage. In the natural cycle, the peak of LH production, the instigator of ovulation, occurs spontaneously. And without control over it, the eggs may not be in the follicles, but already outside – it will not be possible to get them from where.

At the final stage of maturation of oocytes, hCG hormone is injected, which affects the same way as luteinizing. This is how they achieve simultaneous and complete maturation of cells and their readiness for fertilization. As a rule, the injection of chorionic gonadotropin is carried out in the afternoon and after 36 hours a puncture with egg collection is prescribed.

Nowadays, pregnancy after 40 years is a fairly common phenomenon, however, this is exactly the case when pregnancy should be prepared, and especially carefully.

The ideal age for conception, gestation and birth of a child is entered by specialists in the framework of 22-26 years, it is during this period that the hormonal level is optimal, health is tolerable, there are a lot of eggs and they are healthy. Although at this age, deviations from the norm and problems are possible. Nevertheless, a woman’s reproductive system functions not only during this short period, which means that nature allows her to continue childbirth at an older age, up to the onset of menopause, when the resource of eggs is exhausted and the extinction of all occurs. And taking into account the development of modern reproductive technologies, it is quite possible to give birth to a child after the onset of menopause.

Pregnancy after 40 years risk factors

At birth, every girl has a certain supply of germ cells that are consumed throughout her life, which means that the older the woman, the older the follicles stored in the ovaries. Every month, one egg matures and leaves the ovaries, but the remaining follicles are susceptible to aging and external factors, just like any other cells in the body.

This fact is associated with an increased risk of giving birth to a baby with chromosomal abnormalities. Merciless statistics show that the anomaly of the development of the 21st chromosome – Down’s disease in the fetus among women who gave birth at 23-25 is about 1 in 1300, and at 40 it is already 1 in 30. Doctors believe that such statistics also indicate that the mechanism of natural rejection of an embryo with genetic disorders fails with age. And this means that with its full-fledged work, even before the implantation of an egg in the uterus, its removal (chemical pregnancy) would have occurred.

The process of conception itself becomes much more complicated in adulthood, since blood flow to the reproductive organs decreases, the sensitivity of the uterus to sex hormones decreases, some chronic diseases and long-term bad habits, such as smoking, prevent conception and implantation.

It will be especially difficult for women who are planning a pregnancy after 40 years with their first child – gynecologists claim that the reproductive organs, which have been in a state of functional insufficiency for many years, age much faster.

How to prepare for pregnancy

It should be understood that clomid for ovulation stimulation will not solve all problems. First of all, it is necessary to give up bad habits six months before the expected conception, first of all, quit smoking, limit the amount of alcohol and completely abandon all kinds of surrogates, such as low-alcohol and energy drinks.

To give up work that requires strong nervous tension – recent research by scientists suggests that stress at work is one of the factors of problems with conception.

To go in for sports or, at least, to increase physical activity – thus, we increase the elasticity of the joints and strengthen the muscles, which will help to carry and give birth to a baby.

Walk in the fresh air every day, away from car exhaust.

To undergo a full medical examination, in case of chronic diseases, to choose such drugs that are compatible with carrying a child.

To put the oral cavity in order, to cure the teeth. A visit to the dentist during pregnancy is possible, but not at any time and still the risks remain.

Find a doctor you trust, and who will help you prepare for pregnancy and carry a baby.

Ovarian hyperstimulation syndrome is characterized by an increase in the ovaries with the development of numerous cysts (the condition of polycystic ovaries), the accumulation of fluid in the tissues, abdominal cavity and lungs. In 2% of cases, this condition requires immediate hospitalization. The occurrence of ovarian hyperstimulation syndrome is associated with a sharp rise in the level of estrogens (estradiol) under the influence of gonadotropins, which can lead to the rapid development of ovarian cysts.

This disease occurs in 10-20% of cases after ovulation induction, mainly mild and moderate severity. With a mild degree of this syndrome, the ovaries are enlarged to 5 cm in diameter, there is also a slight ascites and weight gain of up to 5 kg. With moderate severity of the syndrome, the ovaries are enlarged from 5 to 12 cm, there is moderate ascites, nausea, vomiting, discomfort in the lower abdomen, and an increase in body weight of more than 5 kg. Severe cases of ovarian hyperstimulation are characterized by an increase in the ovaries, severe ascites, nausea, vomiting, diarrhea, shortness of breath, accumulation of fluid in the lungs, dropsy, blood thickening, and can lead to kidney failure.

Severe forms occur in young women with irregular rare menstruation, who after the first induction had a condition of polycystic ovaries (more than 15 follicles). Hyperstimulated ovarian syndrome has two phases. The first phase manifests itself from the second to the seventh day after ovulation, and the number of signs of the disease is limited. The second phase occurs after a woman becomes pregnant.

How is hyperstimulated ovarian syndrome treated?

Women with mild to moderate syndrome can stay at home, preferably in bed, strictly controlling the amount of fluid consumed and excreted. If, after the induction of ovulation, a woman has dramatically recovered by 1-1.5 kg, it is advisable to hospitalize such a woman. Severe cases should be treated in hospital conditions, taking into account the condition of the woman.

Prevention

When conducting ovulation induction, it is very important to monitor the reaction of the ovaries to the administration of medications, which can be done using ultrasound. If there is a development of 1-3 follicles up to 18-20 mm in size, such induction can be considered safe. However, with the appearance of 5 follicles or more, as well as with a sharp increase in blood estradiol, it is advisable to stop the induction of ovulation.

We continue to answer questions related to ovulation induction

How long can the induction of ovulation with clomiphene citrate be carried out?

Induction with this drug can be carried out for 4-6 months. In 40-45% of all women and in 80% of correctly selected women, pregnancy will occur within 6 months. After six months, it is impractical to carry out ovulation induction.

What gonadotropin preparations are used to induce ovulation?

Gonadotropins are hormones that are produced by the pituitary gland, or substances that have a similar effect to pituitary hormones. Modern medicine uses the following gonadotropins to induce ovulation:

• human menopausal gonadotropin (HMGs)
• human chorionic gonadotropin (hCG)
• follicle stimulating hormone (FSH)
• luteotropic hormone (LH, luteinizing hormone).

What is human menopausal gonadotropin?

Human menopausal gonadotropin is a combination of FSH and LH, mainly created by genetic engineering from mammalian ovarian cells (for example, hamsters). Such combinations have from 60 to 120 units of hormones (depends on the manufacturer). For the first time, FSH and LH were isolated from the urine of menopausal women in 1954, and this combination of hormones was called pituitary human gonadotropins. In menopausal women, the amount of FSH and LH in the urine is increased. The first ovulation induction was performed in 1958, and the first pregnancy after ovulation induction occurred in 1960.

Gonadotropins are most often indicated in cases where the induction of ovulation with clomiphene citrate is unsuccessful, as well as in women with hypothalamic-pituitary factor infertility, when a sufficient amount of FSH and LH is not produced.

What is human chorionic gonadotropin?

Human chorionic gonadotropin is produced by the placenta, and it is obtained from the urine of pregnant women. The chemical structure, and therefore the effect, is almost the same with the pituitary gland LH. Since a sharp increase in LH before ovulation contributes to the maturation of the egg, the introduction of hCG before the expected ovulation leads to the rupture of the follicle and the release of the egg.

To get a positive effect with this type of ovulation induction, it is very important to choose the right day of the cycle for the administration of the drug, which many doctors determine using ultrasound and measuring the level of estrogen in the blood. Ovulation occurs within 36-48 hours after HCG administration. This drug is often used to enhance the effects of clomiphene citrate when it is not possible to trace the peak of LH. Since hCG is excreted in the urine, a pregnancy test may be false positive within 10 days after HCG administration.

What are the side effects of using gonadotropins?

Up to 33% of all pregnancies that occur after the induction of ovulation by gonadotropins are multiple (70% are twins, 30% are triplets). Therefore, the rate of premature birth, and hence the mortality rate of newborns, is increased. A dangerous side effect is ovarian hyperstimulation syndrome (when using hCG, this syndrome is less common than when using other drugs for ovulation induction, in this case we are not talking about clomid and its generics). Other side effects are swelling and soreness of the mammary glands, bloating, abdominal pain, mood changes.

Unlike IVF, the level of fetal malformations after ovulation induction does not exceed the level without ovulation induction. Ectopic pregnancies occur more often after ovulation induction (5-8% of cases compared to 1-2% of cases in the general population of women). Miscarriages are observed in 15-21% of women. Pregnant women after ovulation induction are more likely to suffer from hypertension of pregnant women, and the frequency of placental abruption in such women is increased.

What is ovulation induction?

Ovulation induction is an artificial stimulation of the egg maturation process with the help of medications.

What are the indications for ovulation induction?

Ovulation induction is carried out according to strict indications, since the drugs used for this have many serious side effects in women of certain categories:

• For the treatment of amenorrhea in some cases
• To stimulate ovulation in women with anovulatory cycles
• To regulate the cycle in women with irregular menstrual cycles
  (oligomenorrhea)
• To obtain several eggs in the ovaries of women preparing for IVF (in vitro fertilization) or intrauterine insemination (superovulation).

Healthy women with regular menstrual cycles are not recommended to carry out ovulation induction.

What methods can determine the presence of ovulation?

There are several methods for determining ovulation. Ovulation tests are becoming more popular due to the ease of implementation. They are based on determining the level of LH in a woman’s urine using special strips. The growth and peak of LH levels is observed 32-36 hours before ovulation. Usually, this test is used 2-3 days before the expected ovulation (in women with a 28-day cycle – from 12 to 15 days). In women with irregular cycles, the test should be used from the 11th to the 20th day of the cycle. Ovulation in such women can be confirmed within 5 days in 85% of cases, and within 10 days in 95% of cases. Sometimes ovulation may be absent, which happens normally, however, if ovulation is absent for 2-3 cycles, you need to consult a doctor.

Another method of determining ovulation is ultrasound. Ovulation usually occurs with a follicle size of 1.8‑2.5 cm. This method is more reliable if several ultrasounds are performed in the middle of the cycle every other day. The same method is used by many doctors to control ovulation in infertility clinics. A less common method is an endometrial biopsy with histological examination, which is performed the day before the expected menstruation. This method also allows you to determine the readiness of the endometrium for possible implantation of the fetal egg. Some doctors suggest measuring the level of LH and estradiol in the blood for several days of the cycle. Less and less often women use basal body temperature measurement, since this is not the most reliable method for determining ovulation.

Other questions about ovulation induction in women

Is it possible to use ovulation induction in women who have borderline ovarian tumors removed?

According to new research, it is considered safe to conduct ovulation induction in women after removal of borderline ovarian tumors.

What are the methods of ovulation induction?

Ovulation induction is carried out by one or a combination of several medications, which include clomiphene citrate, FSH, hCG, MGH (human menopausal gonadotropin), bromocriptine, cabergoline, gonadotropin-releasing hormone and its analogues, LH and a number of others.

What are the indications for clomiphene citrate induction?

There are not so many indications for ovulation induction, although many doctors have been abusing this method recently. Induction is indicated for women with rare menstruation or lack of menstruation, those who cannot find out the cause of infertility, with moderate endometriosis, or according to the requirements of the women themselves. The standard dose is 50 mg, for 5 days at the beginning of the cycle. The level of ovulation, pregnancy and the outcome of pregnancy are the same if induction is started on the 2nd, 3rd, 4th or 5th day of the cycle. The doctor should monitor the effectiveness of induction. This can be done by ultrasound, measurement of basal body temperature, determination of the level of estrogen in the blood.

When does ovulation occur after the use of clomiphene citrate?

Ovulation occurs most often 5 days after the last dose of clomiphene citrate is administered, however, in many women ovulation can occur from 10 to 23 days of the cycle, so in such cases it is important to monitor the development of follicles using ultrasound.

What are the side effects of using clomiphene citrate that can hinder pregnancy?

Since clomid is an antiestrogenic drug, it can cause inferiority of cervical mucus, which is very important in the fertilization process, and create a barrier to sperm. Even with successful ovulation, such women may have difficulty conceiving due to the artificial cervical factor of infertility created by doctors. Therefore, to control the quality of cervical mucus, experts recommend conducting a postcoital test in the first half of the cycle after each induction with clomiphene citrate. Another negative result of using clomiphene is a decrease in the quality of the endometrium: it becomes thin and of poor quality for successful implantation of the fetal egg. Some side effects are associated with the occurrence of hot flushes (10% of cases), visual impairment, vaginal dryness, hyperstimulated ovarian syndrome. In 10% of cases, there is a double pregnancy (twins). Some women may experience the growth of ovarian cysts, so before conducting a course of ovulation induction, it is necessary to conduct an ultrasound of the ovaries. Insufficiency of the luteal phase is also not a rare side effect when using clomid (observed in 50% of cases).

When is ovulation induction with clomiphene citrate contraindicated?

Induction of ovulation with this drug is contraindicated in the presence of ovarian cysts, pregnancy, liver diseases.

To be continued…

Unfortunately, some women have difficulties with the production of female germ cells, or with their normal maturation and subsequent fertilization. To solve this problem, such a procedure as ovulation stimulation was developed.

Thousands of married couples today face the problem of conceiving a child, which is due to various negative factors. The absence of ovulation, obstruction of the tubes, abnormalities of the development of reproductive organs – this is not a complete list of reasons that prevent pregnancy. A huge number of women suffering from infertility managed to become happy mothers only with the help of the achievements of modern medicine.

Indications for ovulation stimulation

Hormone therapy aimed at stimulating ovulation is prescribed to women in the following cases:

• with infertility of unclear genesis (if a woman has no objective reasons preventing pregnancy, but even with regular sexual activity throughout the year, conception does not occur);
• with hormonal insufficiency that cannot be corrected by other means;
• when using assisted reproductive technologies that require the collection of eggs from the ovaries (in vitro fertilization, ICSI).

Contraindications to ovulation stimulation

Ovulation stimulation is not prescribed to women who are over 35 years old, who have unsuccessful experience of previous ovulation stimulation (more than six times), as well as patients with structural disorders in the body that prevent conception and the normal course of pregnancy (with obstruction of the fallopian tubes, oncological diseases, acute inflammatory processes, uterine pathologies, etc.).

Reasons for the lack of ovulation

Sometimes the hypothalamic-pituitary system of the body fails, as a result of which a woman has a violation of the menstrual cycle, up to the complete cessation of menstruation.

The reasons for this phenomenon may be:

• genetic: the presence of certain defects in the sex chromosomes that interfere with the normal hormonal background;
• pathological: a tumor or inflammatory process prevents the pituitary gland or hypothalamus from producing a sufficient amount of necessary hormones;
• indirect: the normal course of ovulation is disrupted by dysfunction of the adrenal cortex and thyroid gland, closely related to the pituitary gland and hypothalamus.

Drugs for ovulation stimulation

Currently , ovulation stimulation is carried out with the following medications:

• menstrual (cyclic) gonadotropin. This hormone is produced by the pituitary gland and is responsible for the various phases of the menstrual cycle. Unlike chorionic gonadotropin, which is produced exclusively during pregnancy, ovulation is stimulated by hormones that regulate a woman’s reproductive cycle in her normal state;
• artificially created (recombinant) FSH, most often Gonal;
• Clomiphene, with the help of which the production of gonadotropins is stimulated, due to which ovulation occurs. By binding specifically to the receptors of the hypothalamus and pituitary gland, Clomiphene increases their activity;
• traditional medicine products. Due to the content of analogues of human body hormones in some medicinal plants, preparations based on them contribute to achieving a stable positive effect in the treatment of infertility.

The dose of a particular drug is determined depending on the initial hormonal background. Each woman is selected an individual schedule of reception (ovulation stimulation protocol).

Ovulation stimulation begins on the 3rd-5th day of the menstrual cycle. To control the maturation of the follicles, ultrasound examination is performed daily, as well as basal temperature monitoring.

In addition, it is periodically necessary to take tests to determine the level of estradiol (a hormone produced by the ovaries responsible for the development of the placenta) and cervical number (studies of mucous secretions from the cervical canal: before menstruation, they acquire a more watery consistency).

In case of ineffectiveness of hormonal treatment, the dose of the drug may be increased.

An adequate reaction can be considered in the case of an increase in the follicle by 2 mm per day. If the follicle grows more rapidly, the dose of hormonal drugs must be adjusted, or stop taking them.

Effects of stimulation

The most common negative consequence of ovulation stimulation is ovarian hyperstimulation syndrome (OHSS), which is accompanied by the formation of cysts, stool disorders, fluid accumulation and deterioration of well-being.

In accordance with the degree of OHSS, the disease may in some cases not require therapeutic measures, in others it may even require surgical treatment.

When conducting ovulation stimulation, a woman should control her well-being and listen to any changes in her health. If signs of malaise appear, you should immediately inform your doctor about them.

Ovulation stimulation often threatens the development of ectopic, as well as multiple pregnancies, due to the maturation of a large number of eggs.

One of the complications is the possible development of an allergic reaction to a particular drug taken.

The effect of ovulation stimulation occurs in 10-38% of cases. With the help of this method, the hormonal background is corrected and the necessary conditions are created for the onset of pregnancy.

The positive outcome of ovulation stimulation depends on strict compliance with medical prescriptions and on the positive attitude of the patient herself.

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.