Ovarian stimulation in IVF

Today we will talk about ovarian stimulation, ovulation and IVF. One of the main causes of infertility is a woman’s lack of ovulation – anovulation or very irregular ovulatory cycles-oligoovulation. In the natural cycle, in the area of the follicle that has accumulated, a woman of reproductive age is determined by the yellow body, which prepares the endometrium for embryo implantation. Yellow body in IVF, how can you restore the normal ovulatory menstrual cycle?

The causes of ovulatory disorders can be different, they include various endocrine disorders, as well as problems with the Central nervous system. One of the most common causes of anovulation is polycystic ovary syndrome, overweight or underweight, and chronic stress in women.

There are several ways to determine that a woman does not ovulate. The most affordable method is to measure basal (rectal) temperature over several menstrual cycles. To diagnose anovulation, ultrasound is also used in the dynamics of the menstrual cycle, which tracks the absence of a maturing follicle or yellow body on normal days.

They also take a blood test for sex hormones in the dynamics of the menstrual cycle.

When establishing the fact of anovulation, you need to undergo a comprehensive examination to find out the reason for the absence or irregularity of ovulation, as well as to exclude other possible causes of infertility and identify concomitant diseases.

Preparing for ovarian stimulation in IVF

Normalization of weight

Polycystic ovary syndrome in women often leads to anovulation. These women are often overweight. Before starting drug or surgical ovulation stimulation, weight correction is mandatory. Weight loss of only 5-10% of the original in some cases leads to the appearance of independent ovulation, or improves the body’s response to the effects of medications. Weight deficit also needs to be corrected, since it is known that ovulation is possible in women who weigh at least 45 kg (with an average height of 160 – 170 cm).

Treatment of diseases that caused anovulation

It is necessary to treat all identified causes of anovulation – pelvic inflammatory diseases, hormonal disorders such as hyperandrogenism, hyperprolactinemia, etc. Often at this stage, women restore the ovulatory cycle and begin to grow follicles.

Preparation of the endometrium

Preparation of the uterine mucosa (endometrium) for possible implantation of the fetal egg is carried out. Drugs of female sex hormones – estrogens and gestagens-are prescribed in different combinations, under the control of ultrasound. Hormones promote the growth of the endometrium in the first phase of the menstrual cycle and its secretory transformation in the second phase of the cycle.

Ovarian stimulation. Stimulation of ovulation

Ovulation stimulation is an effective means of restoring fertility in many women with anovulation. In women with an absent or irregular ovulatory cycle, ovulation stimulation may be aimed at obtaining multiple eggs during treatment with assisted reproductive technologies. Careful selection of the treatment program for ovulation stimulation, as well as accompanying monitoring, lead to excellent results. It should be understood that not only natural conception, but also IVF in the absence of ovulation is not possible. Therefore, ovulation stimulation is mandatory for the IVF procedure. It is possible that the sensations during stimulation before IVF will not be pleasant, but the joy of motherhood brings more pleasant sensations. Side effects after IVF are minimal.

Medical stimulation of ovulation

Under the condition of normal spermogram parameters and with passable fallopian tubes, treatment usually begins with drug-induced ovulation stimulation. It can be carried out with the drug clomiphene citrate (klostilbegit). The patient takes medication for 5 days from day 3 to day 7 of the menstrual cycle. From day 8 of the cycle, ultrasound is performed to determine the ovarian response to stimulation and control the growth of the dominant follicle. Based on the results of ultrasound monitoring, the patient is assigned a time for injection of chorionic gonadotropin (pregnil), which stimulates the process of egg maturation and ovulation, and then sexual intercourse.

If the ovaries do not respond well to ovulation stimulation with clostylbegit or pregnancy has not occurred after 6 cycles of ovulation stimulation, then gonadotropin stimulation is recommended. These drugs are more effective than clomiphene citrate, but they require more careful monitoring, because the risk of multiple pregnancies increases.

Surgical stimulation of ovulation

In the absence of the effect of medical stimulation of ovulation, laparoscopy and wedge-shaped resection or drilling of the ovaries (piercing the ovary with an electrocoagulator or laser beam) are performed. These methods partially destroy the dense ovarian capsule, which contributes to ovulation. In the first cycle after the operation, ovulation is monitored. If ovulation does not occur, then in addition is appointed clostilbegyt in the usual way.

When ovulation is stimulated, the following complications are possible: ovarian hyperstimulation syndrome during IVF, multiple pregnancy, and drug-induced liver damage. Signs of hyperstimulation can be different: the state of health worsens when stimulated before IVF, neoplasms (cysts) appear in the ovaries.

Ovarian stimulation and cysts

All medications are prescribed by the attending physician strictly individually, ovulation stimulation is constantly monitored to avoid possible side effects.

Ovarian stimulation in IVF: discharge, sensations, well-being

Why is ovulation stimulation mandatory for IVF?

Pre-IVF stimulation is performed to simulate the normal cycle that results in the maturation of an egg. As a rule, ovarian stimulation for IVF is performed on the 3rd-5th day of the cycle for several days. Much depends on the type of procedure and treatment method. Gonadotropins are administered to the patient intramuscularly or subcutaneously. Menopur stimulation is often performed during IVF. In some cases, antiestrogens are used.

To increase the probability of fixing the zygote after settling, a progesterone drug is prescribed. It helps to preserve the viability of the egg. If IVF IS positive, progesterone should be taken before the 12th week of pregnancy.

With poor ovarian reviews, ovulation may not occur. In this case, repeated stimulation is required.

It should be taken into account that IVF ovulation stimulation has a certain number of acceptable options and after each procedure, the number of eggs in the body decreases. In addition, the stimulation procedure is quite painful. Patients often have abdominal pain when stimulated before IVF, and discharge during stimulation before IVF is also not uncommon.

When performing ovulation stimulation before IVF, it is necessary to exclude the use of other drugs, to warn against viral diseases, to reduce physical activity, and to avoid changes in body temperature. Doctors also advise you to lead a certain lifestyle when stimulated. IVF is possible if you refuse alcohol, caffeinated beverages and sexual contact.

Double stimulation in IVF

If repeated ovarian stimulation during IVF is performed within the same menstrual cycle, then such stimulation is called double. Double stimulation in IVF is directed at the antral follicles of the follicular and luteal phases. Double ovarian stimulation is performed for women with an insufficient number of eggs or women with a lack of time (for example, it is important to preserve fertility before treating cancer). Double stimulation for IVF allows you to get twice as many embryos as with the traditional approach.

IVF with minimal stimulation

In a standard IVF program, ovarian stimulation is performed very actively to get more cells. At the same time, the choice of embryos of the best quality and their development to the desired stage is more likely. However, there are a number of indications that ovarian stimulation before IVF is better to start with minimal stimulation. Minimal IVF stimulation involves going through the same stages of stimulation as the standard IVF Protocol, with the only difference that:

  • lower doses of hormonal drugs are used,
  • few follicles Mature during the cycle,
  • and there is no risk of ovarian hyperstimulation.

Usually, a woman is prescribed a hCG test after IVF to confirm pregnancy. And if the analysis showed that conception did not occur, then the monthly period after IVF will come necessarily.Usually, monthly periods after a negative IVF result occur on the 3rd — 12th day.Monthly periods during IVF pregnancy (successful conception), it is possible to continue poor menstruation during the first 2-3 months. However, there should be no blood clots or lower abdominal pain.

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