Long ago in the past, there were times when problems with ovulation in a woman meant only one thing for a married couple — infertility. Medicine has learned to successfully solve this problem, and in many cases, treatment ends with conception and the birth of a healthy child. In this case, ovulation stimulation is performed with drugs that are individually selected for each patient in accordance with her physiological characteristics. We will tell you in which cases the doctor can prescribe ovulation stimulation, what should precede it, what is the scheme of the procedure and its effectiveness.
Why do we need the stimulation of ovulation
Ovulation stimulation is prescribed only if there are direct indications for it, since if the woman’s reproductive system is in order, then she herself produces viable eggs.
Ovulation in a healthy woman of childbearing age is the process of releasing a fully Mature and ready-to-fertilize egg from the follicle. Exit is preceded by a long preparation. Once a month, several eggs sleeping in the ovary are awakened by hormones and begin to increase in size. After about ten days, the dominant follicle is released from them, the size of which can reach 18-20 mm. When the egg is fully Mature, the follicle shell is torn. The egg goes into the abdominal cavity, and then enters the fallopian tube. There, within 24 hours, she waits for fertilization. If it does not happen for some reason, the egg dies and the whole process is repeated in a month. Usually one egg is involved in ovulation, but sometimes there are two or three. In this case, twins are born. If the embryo divides itself into 2 parts after fertilization (that is, initially these 2 parts were formed from one egg and one sperm), then twins are born.
In some women who are ready to become mothers both physically and mentally, pregnancy does not occur because her ovaries do not form a Mature egg. If conception does not occur for 6 consecutive cycles, ovulation stimulation may be prescribed. It has a single goal — to help the body form a full-fledged egg, capable of fertilization, and push it to exit the follicle. The essence of the method is to target the ovaries with certain medications in order to increase the release of hormones necessary for ovulation.
Ovulation stimulation for conception, the doctor prescribes only if there are:
- Anovulatory infertility (hormonal dysfunction that is incurable in another way; polycystic ovary; a woman’s high or low body mass index;)
- Preparation for artificial insemination by IVF.
- Infertility of unknown origin.
Preliminary study
Before starting the ovulation stimulation procedure, the doctor necessarily prescribes a number of studies, both laboratory and instrumental. Their purpose is to identify possible contraindications:
- hormonal disorders;
- inflammatory processes of the pelvic organs and ovaries;
- violations of the patency of the fallopian tubes.
A relative contraindication is the age of a woman over 40 years, because in this case, the risk of giving birth to a sick child increases.
So, instrumental research includes:
- Examination of the therapist to identify common diseases in which pregnancy is contraindicated.
- ECG.
- Ultrasound of the pelvis and mammary glands.
- Examination of the patency of the fallopian tubes by laparoscopy or radiography with contrast material.
- Folliculometry.
- Fluorography.
- Types of laboratory tests:
Clinical blood test.
- Blood tests for syphilis, HIV, hepatitis B and C.
- The General analysis of urine.
- PCR – examination of smears from the vagina and cervical canal.
- Examination of smears from the vagina, cervical canal and urethra for atypical cells and the degree of purity.
- Infectious examination (for chlamydia, ureaplasmosis and mycoplasmosis, gonorrhea, trichomoniasis, etc.).
- Determination of the blood level of female sex hormones, thyroid hormones, prolactin and testosterone (performed repeatedly).
After a full examination and obtaining a medical opinion on the absence of diseases that can prevent conception or provoke the birth of a sick child, it is necessary to assess the ovarian reserve of a woman. Using this procedure, is defined by:
- the chance to receive in the process of stimulating ovulation of a positive result;
- intensity of stimulation;
- optimal scheme;
- the most effective drugs and their individual dose.
To assess the ovarian reserve, a woman gives blood for analysis after taking hormonal drugs. Based on the obtained indicators, a conclusion is made about the prospect of artificial ovulation stimulation.
The choice of the scheme of hyperovulation
Ovulation stimulation is performed according to one of the regulated schemes, which describes in detail the method, dose and duration of administration of the drug. The doctor selects the scheme taking into account:
- result of ovarian reserve assessment;
- female body mass;
- the results of the previous stimulation procedures (if any).
All drugs used for stimulation are hormonal, but differ from each other in the type of hormone they are based on — follicle-stimulating or luteinizing (necessary to support the development of the egg). There are four groups of tools for ovulation stimulation.
- Preparations based on HMG (human menopausal gonadotropin), containing follicle-stimulating (FSH) and luteinizing (LH) hormones in the same proportion. This includes, for example, “Menopur”.
- Drugs based on FSH, whose principle of action is close to the natural hormone — “Gonal”, “Puregon”.
- Drugs that are based on the suppression of estrogen and increase the level of FSH to the required norm — “Clostylbegit”, “Clomid“, “Clomifen”.
- Hormonal agents that stimulate the rupture of the follicle shell and the timely release of the egg – “Prophase”, “Horagon”, “Pregnil”, “Ovitrel”.
Usually, a combination of drugs is used in the schemes.
Ovulation stimulation is recommended to be performed no more than 6 times, since it can lead to depletion of the ovaries. If the desired pregnancy does not occur as a result of stimulation, it is necessary to choose other methods of treatment.
Despite the fact that ovulation stimulation is a well-established method of treating infertility, it should be remembered that it also has its own limits of application, indications and contraindications, and side effects. In addition, even if it did not lead to the long-awaited result, it is important to know: modern Reproductology is not limited to this method.