Controlled Ovulation Induction (CIO)

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

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

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

controlled ovulation induction

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

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

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

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

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

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

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