Questions that few people ask before IVF

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.

IVF questions

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.

Reasons for the lack of ovulation

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.


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.

lack of ovulation

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.

Lack of ovulation (anovulatory cycle)

Anovulatory cycle – how to wake up sleeping eggs. In the ovary there are special structures – follicles in which eggs mature. In the middle of the cycle, the follicle ruptures, releasing the mature germ cell into the fallopian tube to meet the sperm. However, in some cases, the egg does not leave its container and does not seek to fertilize.

Cycles that are not accompanied by ovulation are called anovulatory. Such a violation leads to infertility.

How the female body works and why nature fails

Normally , the menstrual cycle is divided into three phases:

  • Follicular, occurring after the end of menstrual bleeding. During it, the cerebral appendage – the pituitary gland – secretes follicle-stimulating hormone (FSH), which “spurs” the development of follicles, one or two of which will burst in the middle of the cycle and release mature eggs. In parallel, the ovaries increase the production of female hormones-estrogens, especially estradiol.
  • Ovulatory – closer to the end of egg maturation, the production of another hormone – luteinizing (LH) begins. Under its influence, ovulation occurs. The follicle bursts, and the egg goes into the fallopian tube to meet the sperm.
  • The phase of the corpus luteum, during which the fertilized cell descends into the uterus and is implanted. The burst follicle turns into a yellow body, secretes progesterone and sex hormones necessary to maintain pregnancy.

With an anovulatory cycle, this system gets lost. Most often, the violation is associated with a change in the concentration of female hormones, which may be too much or too little. Due to hormonal imbalance, there is a significant thickening of the inner uterine layer – the endometrium.

After reaching a certain limit, the mucosa begins to peel off, which leads to a violation of the integrity of the vessels and menstrual bleeding. Its strength and duration can be different and vary from month to month. The constant thickening of the mucosa leads to the formation of polyps – mushroom-like growths, which further complicate fertilization.

In some periods of life, for example, in puberty (adolescence) and when entering menopause, this situation is considered the norm and does not require treatment. Periodic anovulatory cycles in a healthy woman are also not dangerous. Medical care is required if there is a constant absence of ovulation, which does not allow getting pregnant and negatively affects the state of health.

Causes of anovulatory cycles

  • Pathologies of the pituitary gland – the cerebral process that secretes hormones that ensure the maturation of the follicle and the release of the egg. The causes of his work disorders may be brain injuries, infections or congenital underdevelopment.
  • Prolactinemia is the production of prolactin, which normally should be responsible for breastfeeding, milk production and inhibit ovulation during breastfeeding. However, in some cases, the concentration of this hormonal substance increases outside the lactation period, leading to inhibition of egg development. The causes of this phenomenon are pituitary tumors, taking certain medications, cirrhosis of the liver, kidney diseases.
  • Diseases of the thyroid gland, the hormones of which affect the work of all body systems. Thyroid insufficiency inhibits ovulation, and in severe cases can lead to amenorrhea – the cessation of menstruation.
  • Adrenal hyperfunction. Anovulatory cycles occur with increased production of male hormones by these organs – androgens.
  • Pathological processes in the ovaries that disrupt the production of female hormonal substances – estrogens. Such a condition can provoke cysts and chronic adnexitis (inflammation). Anovulatory cycles are common for polycystic ovarian disease, in which the eggs do not ovulate, but remain inside the follicles, turning into small cysts.
  • An abortion performed at a late date. In this situation, the body, which has tuned in to carrying a child, gets the strongest stress. Hormonal failure occurs, leading to the shutdown of ovulation.

anovulatory cycle

Symptoms of the anovulatory cycle

The complaints accompanying this violation depend on the level of hormones:

With a normal hormonal background, the absence of ovulation does not cause any complaints. According to the number of days and the volume of blood lost, the menstrual-like reaction that has occurred fits perfectly into the standard critical days. The patient learns about the problem when she decides to have a child. Conception does not occur in any way, and by contacting a doctor, the patient learns about the existing violation that led to infertility.

With increased production of female estrogen hormones – hyperestrogenism – prolonged copious menstrual discharge may occur, leading to anemia (anemia). Sometimes, due to hormonal imbalance, blood clotting decreases, which aggravates the situation.

With a decrease in the amount of female hormones – hypoestrogenia – menstruation becomes short, sparse, irregular.

Treatment anovulatory cycle

A woman is prescribed ovulation stimulation with the help of medications that affect the growth of eggs and their exit from the follicle. Medications allow you to “wake up” follicles containing eggs. The process is controlled by a gynecologist, who prescribes periodic ultrasound examinations of the ovaries, fixing the exit of germ cells into the fallopian tubes.

Against the background of the treatment, the possibility of pregnancy increases by 70%. However, artificial ovulation often knocks out several eggs from the ovaries, which increases the likelihood of multiple pregnancies.

Clomiphene: Characteristics of the substance

Characteristic of the substance Clomiphene is a white or white crystalline powder with a cream tint. Slightly soluble in water, moderately soluble in alcohol.

Pharmacological action is antiestrogenic. Binds estrogen receptors in the hypothalamus and ovaries. When ingested, it is well absorbed from the gastrointestinal tract. It is metabolized in the liver. It is excreted with bile, undergoes enterohepatic recirculation. It is excreted from the body with feces. T1/2 is 5-7 days. In small doses, it enhances the secretion of gonadotropins, stimulates ovulation. With a low content of endogenous estrogens in the body, it has a moderate estrogenic effect, with a high level — antiestrogenic. By reducing the level of circulating estrogens, it promotes the secretion of gonadotropins. In large doses, it inhibits the secretion of gonadotropins. It does not have gestagenic and androgenic activity.

Application of the substance Clomiphene

Anovulatory infertility (ovulation induction), dysfunctional uterine bleeding, amenorrhea (dysgonadotropic form, secondary, postcontractive), galactorrhea (against the background of pituitary tumor), polycystic ovaries (Stein—Leventhal syndrome), Chiari-Frommel syndrome, androgen deficiency, oligospermia, for the diagnosis of disorders of the gonadotropic function of the pituitary gland.

Anovulatory infertility (ovulation induction); amenorrhea (dysgonadotropic form), secondary amenorrhea, post-contraceptive amenorrhea; Stein-Leventhal syndrome (polycystic ovary syndrome); oligomenorrhea; galactorrhea (on the background of a pituitary tumor); Chiari-Frommel syndrome (syndrome of prolonged postpartum amenorrhea-galactorrhea); androgen deficiency; in men – oligospermia.



Hypersensitivity, severe hepatic and/or renal insufficiency, uterine bleeding of unknown etiology, ovarian cyst, tumor or insufficiency of pituitary function, pregnancy (including suspicion of it).

Hypersensitivity to clomiphene; pregnancy, lactation (breastfeeding); ovarian cyst (with the exception of polycystic ovarian syndrome); tumor or hypofunction of the pituitary gland; thyroid or adrenal dysfunction; metrorrhagia of unclear etiology; long-term or recently developed visual disturbances; neoplasms of the genitals; endometriosis; ovarian insufficiency against hyperprolactinemia.

Special instructions

It is recommended to check liver function before using clomiphene.

Before using Clomid, it is necessary to conduct a thorough gynecological examination. The use of clomiphene is indicated in cases when the total level of gonadotropin in the urine is below the lower limit of the norm or at the normal level, ovarian palpation does not reveal deviations from the norm, and the functions of the thyroid gland and adrenal glands correspond to the norm.

In the absence of egg maturation, all other possible causes of infertility should be excluded or treated before the use of clomiphene. If an increase in the ovaries or their cystic transformation is detected, the use of clomiphene is not allowed until the ovaries return to normal size. In the future, the dose or duration of treatment should be reduced.

In the course of treatment, constant supervision of a gynecologist is necessary, ovarian function should be monitored, vaginal examinations should be performed, and the phenomenon of the “pupil” should be observed. Often during the course of treatment it is difficult to determine the moment of ovulation, and there is also often a deficiency of the corpus luteum. Therefore, after conception, it is recommended to start preventive administration of progesterone.

Effectiveness of clomid

Effectiveness of clomid: Arrighi’s data on the low efficacy of clomiphene in patients with an inferior luteal phase confirm the good results we have obtained in the treatment of this pathology with synthetic progestins. So, according to Townsend, clomiphene will give effect only with a daily excretion of estrogens of at least 10 mcg /day. According to other authors, ovulation stimulation with clomiphene is possible only in patients with estrogen excretion of at least 20 mcg per day.

There are indications of low efficacy of clomiphene in patients with initial high gonadotropin secretion. Obviously, this applies to patients whose ovarian tissue is unable to respond to stimulation with gonadotropins and clomiphene.

A summary analysis of the data on the use of clomiphene in 6714 patients with anovulation, conducted by Macgregor, showed that ovulation appears in 70%, and pregnancy occurs only in 32.7% of women. Such a discrepancy between the frequency of ovulation and the onset of pregnancy is usually explained by the appearance of cyclic secretion of LH at an inappropriate time, resulting in premature luteinization of follicles without full ovulation.

Purpose and effectiveness of clomid

The administration of clomiphene in patients with impaired gonadotropin secretion revealed its low effectiveness compared to gonadotropins. In addition, it should be noted that every 5th woman with the onset of pregnancy after the use of clomiphene has an interruption in the second trimester (18.5%).

Our own experience of using clomiphene in 51 patients (in the presence of anovulation in 22 and an incomplete luteal phase in 29) showed that ovulation occurred in almost all women, and pregnancy occurred only in 18 of 51, i.e. in every third patient.

effectiveness of clomid


At the same time, the best effect was achieved in patients with anovulation. Ovulation was confirmed by an increase in the excretion of total estrogens by 2-3 times, and pregnanediol by 3 times. In most patients, 10-12 days after the end of taking clomiphene, the excretion of estrogens increases to 50-70 mcg / day and ovulation occurs, followed by an increase in basal temperature and the excretion of pregnanediol. If pregnancy has not occurred, then a menstrual-like reaction occurs 10-12 days after the basal temperature rises.

The effectiveness of clomid (treatment with clomiphene) in patients with estrogen excretion below 10 mcg / day was insignificant. Only 1 out of 8 patients with prolonged amenorrhea became pregnant. The relatively low effectiveness of treatment with clomiphene in patients with an inferior luteal phase was also noted.

Blood and testosterone

So, blood and testosterone. The red bone marrow is the most important organ of the hematopoietic system in humans, which carries out hematopoiesis, or hematopoiesis — the process of creating new blood cells to replace dying and dying ones.

Hematopoiesis is the blood production that occurs in the bone marrow, due to stimulation by erythropoietin.

Erythropoietin is a hormone synthesized in the kidneys. It stimulates the formation of red blood cells in the bone marrow.

Erythrocytes are blood cells containing hemoglobin. Their main function is to deliver oxygen to tissues and organs.

Hemoglobin is a protein contained in red blood cells and carries out the exchange of oxygen between the lungs and tissues of the body.

Hematocrit is defined as the ratio of the total volume of all shaped elements to the total volume of blood.

Platelets are blood cells in the form of blood plates, whose main function is to participate in blood clotting. They are formed in the bone marrow and protect the body from bleeding, as well as react to vascular damage by forming blood clots.

Steroids and blood

Blood and testosteroneЖ When it comes to the side effects associated with the use of testosterone, the term “Thick blood” often arises, this term is not particularly scientific and does not mean what it really is.

Blood and testosterone

In fact, the so-called thick blood is an increase in the amount of hemoglobin and red blood cells, which in turn leads to an increase in hematocrit. It is the increase in hematocrit that is the increase in blood density, which is due to the intake of testosterone. Since testosterone increases the secretion of erythropoietin, which significantly stimulates hematopoiesis.This is a normal situation when taking testosterone, so you should not always worry if hematocrit grows. The main thing is that the hematocrit remains within the reference values, norms.

Blood and testosterone: Norms

Hematocrit – 39-51%

Hemoglobin – 130-170 g/l

Erythrocytes – 4.2-5.7 million/ml

Platelets — 180-350 thousand/ml

In turn, increased hematocrit will lead to certain side effects. In fact, there are two of them. The first is an increase in the load on the cardiovascular system, because of the thicker blood, the movement of blood through the vessels is hampered, which leads to an increased load on the heart and blood vessels. This usually manifests itself in the form of increased blood pressure and heart rate. The second is the risk of blood clot formation, the risk of thrombosis. This is due to an increase in the number of red blood cells.

Prerequisites for an increase in hematocrit

  1. Smoking
  2. Insufficient water consumption

An increase in hematocrit, erythrocytes and hemoglobin is called Erythrocytosis. Erythrocytosis is of two types, primary and secondary. Primary erythrocytosis – occurs as a result of true polycythemia, a myeloproliferative neoplasm in which pathological cells in the bone marrow produce too many red blood cells. Secondary erythrocytosis develops as a result of a disease in which the secretion of erythropoietin increases. Erythropoietin is a hormone that is synthesized in the kidneys and stimulates the production of red blood cells by the bone marrow.

Blood and testosterone: Elevated platelets

Risk of thrombosis. An increase in platelets is called thrombocytosis. There are two types of thrombocytosis: Primary and secondary. Primary thrombocytosis, in this case, an increased number of megakaryocytes is formed in the bone marrow, which increases the number of platelets having a normal lifespan, but an incorrect structure and impaired functions. Secondary (reactive) thrombocytosis. With it, platelets function normally, and the cause of the disease itself is some other deviation.

Take even clomid very carefully. When taking pharmacology, secondary thrombocytosis develops. It passes after the withdrawal of drugs.

Methods of reducing hematocrit


Phlebotomy is bloodletting. The procedure is resorted to in the case of polycythemia, a hematological disease in which too many red blood cells, leukocytes, platelets are produced in bone marrow cells, which can lead to thrombosis.


Erythrocytapheresis is a method of extracorporeal hemocorrection based on the removal of certain cellular components of the patient’s blood – erythrocytes. The indications for it correspond to the indications for ordinary bloodletting.

Blood and testosterone: Conclusions

Using chemotherapy drugs to reduce hematocrit, while increasing the risk of developing leukemia, instead of doing erythrocytopheresis or phlebotomy, which are very safe, does not seem to be a very good idea.

In general, discussing the number of side effects and the effectiveness of interferon alpha, hydroxyurea or pipobrovan, which, by the way, is more preferable than hydroxyurea, would make sense if not for one thing — erythrocytapheresis or phlebotomy have no side effects at all and they are more effective.

From the author: My guess is that in general someone thought of using these drugs instead of draining blood just because he was too lazy to go and drain the blood, since it’s obviously easier to take a pill. I’m still in shock that someone is seriously considering taking such drugs. Yes, hematocrit 54% will be safer than taking hydroxyurea. It will be safer to do nothing here than to do something.

Clomiphene therapy is over, and testosterone is holding up.

Clomiphene therapy is used primarily as a supportive therapy for secondary hypogonadotropic hypogonadism or testosterone deficiency. With hypogonadotropic testosterone deficiency, LH, the pituitary hormone that stimulates the testicles to release testosterone, decreases. The reason for the decrease in LH, most often, it is impossible to determine. The main, and most frequent, reason is age. With age, LH decreases significantly, which leads to a deficiency of testosterone.

Clomiphene therapy

The main goal of clomiphene therapy is to maintain LH at higher values. It should be understood that clomiphene therapy is not curative, it will not “cure” the testicles or pituitary gland, so that later more hormones are released for a long time than before the start of therapy. Clomiphene increases LH only for as long as it works. As soon as clomiphene is canceled, the LH level begins to decrease to the same values that were before the start of therapy.

clomiphene therapy

On the graph, you can see how testosterone behaves on maintenance therapy for a year, from 1 to 13 tests, which were once a month. 14 the delivery of tests was 4 months after the cancellation of clomiphene. In this analysis, the level of testsoteron returned to the same values that were before the start of therapy.

From this graph, it can be seen that the testosterone level was good only while taking clomiphene, and there is no effect of testosterone retention after discontinuation of medications in maintenance therapy.

Interesting notes on therapy

  1. Testosterone in good values, more than 20+ nmol/L, does not come out very quickly. Initially, the man had a very low testosterone of 9 nmol/ l, after a month it rose only to 14.6 mmol / L. After 2-3 months it was at the level of 20 nmol/ l and only after 5-6 months it reached 30 nmol/l.
  2. There may be fluctuations in testosterone levels on the therapy itself. Here is an example of the fact that throughout the year testosterone fluctuated between 20-30 nmol/L. This happens if testosterone has dropped from 30 nmol/l to 20 nmol/l, this does not mean that therapy does not work, it’s time to finish and only HRT remains. Such fluctuations can be – this is normal. The main thing is to compare testosterone not only with the previous analysis or analysis at the highest point, but also with the initial analysis. Even if testosterone drops from 30 nmol/l to 20 nmol/l, it is still 2 times more than the original 9 nmol/l.
  3. After maintenance therapy, testosterone does not hold at all. Clomiphene therapy is initially a stimulating, supportive therapy. It increases the level of LH, which is low for one reason or another, which increases and keeps the testosterone level in good values. After the withdrawal of clomiphene, essentially what stimulates the level of LH, testosterone levels are reduced to the initial tests. In this case, the analysis with 30 nmol/l was in early March. Then the coronavirus and self-isolation, the cancellation of medications and tests in early July, the testosterone level is the same as the original one, which was almost 2 years ago.

Contraindications to ovulation stimulation

Ovulation stimulation

Ovulation stimulation is a technique of influencing the work of the ovaries, which is carried out within the framework of in vitro fertilization programs or situations when there is no ovulation of one’s own. The procedure allows you to eliminate one of the common causes of female infertility – the inability of the ovaries to form a mature egg and, thus, maximize the chance of pregnancy. Are there any contraindications to ovulation stimulation?

What is ovulation stimulation?

The essence of stimulation is the appointment of hormonal drugs that increase the level of hormones necessary for ovulation and, thereby, ensure the growth of follicles in the ovaries to the state of mature, preovulatory.

The drugs are administered strictly according to the scheme drawn up by a reproductive doctor, taking into account the age, health status and reproductive system of a woman.

The procedure allows you to get more eggs ready for fertilization and is successfully used both in assisted reproductive technology programs.

Ovulation stimulation and pregnancy

The complete or partial absence of natural ovulation is one of the most common causes of female infertility. In this case, an additional push with the help of hormonal drugs allows you to achieve pregnancy naturally without the use of IVF and other reproductive technologies.

Ovulation stimulation for conception is carried out under the condition of complete patency of the fallopian tubes and good sperm counts in the partner. The first attempts are carried out using tablet preparations. As the egg matures and exits, the doctor informs the patient of the most favorable days for conception. The protocol ensures the maturation and release of one, rarely two eggs, as it happens with a natural cycle.

If pregnancy does not occur within 6 months of attempts, reproductologists prescribe injectable drugs. Their use significantly increases the likelihood of pregnancy in general and multiple pregnancies, in particular, since it often promotes the growth of several germ cells.

Contraindications to ovulation stimulation

If there are no other obstacles to pregnancy, doctors recommend using ovulation stimulation, since the price of the procedure is significantly lower than the cost of other reproductive technologies.

Contraindications to ovulation stimulation

Hormones used to stimulate ovulation significantly change the work of the body, which is why doctors pay special attention to the state of a woman’s health. Contraindications to ovulation stimulation in the presence of the following problems:

  • the patency of the fallopian tubes is disrupted or not investigated (if it is planned to stimulate the ovaries for pregnancy naturally);
  • when the follicular reserve is depleted (determined by the level of follicle-stimulating hormone);
  • the duration of infertility treatment is 2 years or more;
  • there are diseases of internal organs or mental abnormalities that are a contraindication for pregnancy;
  • tumors of the uterus or ovaries were detected;
  • the ovaries are enlarged or contain cysts in their structure;
  • there are signs of inflammation (regardless of its location);
  • the woman suffers from uterine bleeding of unknown origin;
  • the functioning of the liver or kidneys is significantly impaired;
  • there are disorders of the endocrine glands that cannot be corrected;
  • the woman does not tolerate any component of the drug;
  • a woman is 40 years old or older.

Natural conception

Natural conception is what future parents who are planning a pregnancy are striving for. It is natural: without the intervention of doctors! Fortunately, in the vast majority of cases, pregnancy occurs “by itself”, without any special manipulations. Some parents are examined before planning, and sometimes they “calculate” the necessary days to achieve the goal faster.

What should I do if I can’t get what I want? To begin with, it is worth remembering exactly how conception occurs.


During sexual intercourse, spermatozoa enter the vagina and begin to move along the reproductive tract: through the cervix, the uterine cavity, and then, through the hole in the tube corners, into the tubes. It is in one of the tubes that they meet with the egg. The embryo formed as a result of fertilization moves towards the uterus and on the 5th-6th day of development enters the uterine cavity, where implantation takes place (attachment to the uterine wall).

In other words, in order for this meeting to take place, it is necessary to comply with the mandatory conditions: the pipes must be passable, and the sperm must be capable of fertilization (as doctors say, be fertile enough).

Determining the day of ovulation

If these conditions are met, sexual intercourse should occur as close as possible to ovulation; to understand exactly when ovulation will occur, it is enough, for example, to install an application on a smartphone, and it will indicate “dangerous” days. Or, calculating the duration of the cycle, divide the number of days from menstruation to menstruation (take 30 days for convenience) by two. It is during this period (in our example, it is 15-16 days) that ovulation should be expected. It should be taken into account that phase II is usually no shorter than 13-14 days. You can use the services of a gynecologist who, with the help of ultrasound, will be able to very accurately determine the day of ovulation – doctors call such a scheme “programmed conception“.

Natural conception – Additional recommendations

A married couple planning a pregnancy should naturally adhere to some recommendations that will reduce the risk to offspring and facilitate pregnancy. This kind of advice is given to the family, bearing in mind that compliance with them is desirable for both spouses. It is recommended to give up smoking tobacco and other smoking herbs, from the use of strong alcohol, drugs; walks in clean air and the absence of inflammatory diseases are desirable (relevant during epidemics). Reception of vitamin and mineral complexes – taking into account the season and the region of residence.

The only recommendation only for a woman is taking clomid or folic acid at a dose of 400-800 mcg, which reliably prevents the pathology of the neural tube in the unborn child; admission should begin 2-3 months before the planned pregnancy.

How is the stimulation for conception carried out in a natural way

Stimulation is possible only if the patency of the tubes and the fertility of the sperm are proven, it is also necessary to make sure that there is no pathology of the uterus and appendages; in some cases, the Kurzrock-Miller test is performed (a test for compatibility of sperm and cervical mucus). With an unspecified condition of the fallopian tubes and the general condition of the reproductive organs (pelvis, uterus, appendages), stimulation can lead to extremely undesirable consequences, of which the most formidable is ectopic pregnancy. Naturally, ectopic pregnancy can occur regardless of whether there was stimulation, but unjustified stimulation creates conditions under which the occurrence of ectopic pregnancy is more likely.

For stimulation, in most cases, so-called gonadotropins are used. It is accepted to prescribe small doses from 4-6 days of the menstrual cycle. The doses and the day of the start of stimulation are selected in such a way that 2-3 follicles grow in the cycle. It is the growth of more than one follicle (and therefore an egg) that increases the chances of pregnancy in this cycle. The purpose of stimulation is jewelry work: it is important to prevent the growth of a large number of follicles, and, at the same time, to achieve synchronous growth of two or three. It is customary to prescribe a trigger drug that will help the follicles to circulate at the same time and tell you exactly when you need to try to conceive a child.

We add that by agreeing to stimulation for conception, parents should be aware that such stimulation increases the likelihood of multiple pregnancies, because mature eggs have an equal chance of fertilization.

A special situation is when stimulation is used to treat anovulation (absence of spontaneous ovulation): the purpose of treatment in this case may consist in a whole range of measures, depending on the cause of the pathology.

Female hormonal stimulation of ovulation

Hormonal stimulation of ovulation: many women who undergo infertility treatment by in vitro fertilization (IVF) are often interested in questions:

  • Do hormonal drugs used during IVF reduce the ovarian reserve?
  • Won’t all the follicles be taken away during ovarian puncture?
  • Will hormonal stimulation bring the onset of menopause closer?

As part of this short article, we will try to answer the questions posed. And let’s start with the theoretical part.

Hormonal stimulation of ovulation

Ovarian (ovarian) reserve is an internal reserve of the ovaries, which determines their ability to develop a healthy follicle with a full-fledged egg. The ovarian reserve not only reflects the total number of follicles contained in the ovaries, but also their functional state.

The follicular reserve is laid in utero, is not replenished during a woman’s life, does not increase, is individual, and normally by the time of the formation of menstrual function, a girl has an average of 270,000- 470,000 follicles.

hormonal stimulation of ovulation

During one menstrual cycle, as a rule, one follicle grows and reaches the ovulation stage. On average, 400-500 follicles reach ovulation in a woman’s entire life, and the rest undergo atresia (reverse development). Thus, with each menstrual cycle, the total number of follicles decreases, and with their complete disappearance, menopause occurs. The mechanisms of atresia and apoptosis ensure the survival of the strongest follicles, in which genetically healthy oocytes are most likely to mature.

In natural conditions, by the beginning of the next menstrual cycle, a cohort of antral follicles is formed in a woman, of which one pre-ovulatory is isolated by the time of ovulation, while the rest undergo reverse development.

Hormonal drugs

Hormonal drugs used during the IVF program, the so-called “ovulation inducers”, have an effect on almost all follicles that have reached the antral stage, without affecting the entire ovarian reserve. Thus, in a stimulated cycle, it is possible to obtain high-quality eggs even from those follicles that would be “lost” to a woman under natural conditions. From this it can be concluded that stimulation does not lead to premature depletion of the follicular apparatus, does not reduce fertility and, thereby, does not bring the age of menopause closer.

All of the above confirms that the most important physiological factors determining the ovarian reserve are the genetic predisposition and age of the patient.

Studies conducted in recent years have shown that the rate of follicle disappearance doubles when the primordial pool is reduced to 25,000 follicles, which normally corresponds to the age of 37.5 years. This age is defined as critical, after which the ovarian reserve itself decreases sharply. However, there are significant individual characteristics in the time of menarche (10-16 years), the time of menopause (45-55 years), the onset of which is determined only by the individual biological age of a woman.

The correct selection of the stimulation scheme will allow you to get the optimal number of the highest quality eggs without causing any harm to health.