Clomiphene ™

Absence of pregnancy – one of the causes of female infertility is premature ovarian failure. In 74% of cases, the only chance to get pregnant is to perform in vitro fertilization using donor oocytes. In this regard, it is relevant to search for new approaches to solving this problem.

The incidence of premature ovarian failure in the female population is 1.5%, and in the structure of secondary amenorrhea-up to 10%. There are several theories that explain the causes of ovarian insufficiency: pre-and post-pubertal destruction of oocytes, chromosomal abnormalities, autoimmune disorders, etc. A typical portrait of a patient: a young girl with the presence of menopausal symptoms, who does not become pregnant against the background of secondary amenorrhea. The diagnostic criteria for insufficiency include oligomenorrhea, amenorrhea for 4-6 months, the level of follicle-stimulating hormone (FSH) in the blood above 25 IU/l in two studies with an interval of at least four weeks, a decrease in the level of estradiol (E2) and anti-muller hormone (AMH) in the blood.

Hormone replacement therapy is recognized as a pathogenetic approach to treatment. However, at the moment, there are no effective treatment regimens that can improve the prognosis for fertility recovery. An alternative method of treatment is placental therapy with the drug Melsmon.

Clinical case absence of pregnancy

A 22-year-old patient came to the medical center with complaints about the absence of menstruation (amenorrhea) for a year and the absence of pregnancy for four years, a feeling of hot flashes up to ten times a day, hyperhidrosis, decreased libido, lethargy, increased fatigue, shortness of breath, insomnia. The patient has been married for four years, the first marriage, with a regular sexual life in the absence of any methods of contraception, pregnancy in this marriage did not occur. The patient’s husband underwent a study of the state of reproductive health. The male factor of infertility is excluded. Menstruation in a patient from 11 years old, established immediately, duration-five days, after 30 days.

From the anamnesis, it is known about the violation of the menstrual cycle in the form of scanty bloody discharge (oligomenorrhea) and their gradual disappearance. When examined in the mirrors, a fibrous polyp of the cervical canal was found. A hysteroscopy was performed with separate diagnostic curettage and removal of the cervical canal polyp. Histological conclusion: glandular endometrial hyperplasia with elements of polyposis on the background of chronic endometritis. Fibrotic polyp of the cervix. The somatic history is not burdened. No previous tests have been performed for sexually transmitted infections. He has no professional harms or bad habits. For four months, in order to regulate the menstrual cycle, she took Regulon (she did not take the drug clomid), then stopped taking it due to a sharp increase in the body mass index (after the withdrawal of the drug Regulon, the weight returned to its previous values).

When collecting a family history, it turned out that the mother’s menstrual function stopped at the age of 34. Due to the lack of pregnancy, the family is under stress.

Approximately 20% of married couples who have difficulties with conception, this is because, a woman’s ovaries do not produce and release an egg in each menstrual cycle (anovulation). Clomid acts by causing a gland in the brain (the anterior pituitary gland) to release hormones that stimulate ovulation.

It must be remembered that there are many causes of anovulation, so Clomid may not be effective in all cases.

When accepting Clomid, it should be 28-32 days from the beginning of one period to the next. Your ovaries should release the egg 6-12 days after a course of Clomid. You should have sexual intercourse at this time to increase your chances of conception.

If menstruation does not arrive after the 35th day there are two likely possibilities: the dose of Clomid was not enough to get ovulation, or you are pregnant.

If your menstrual period is overdue, contact your doctor who wrote you a prescription for clomid and he will advise you what steps to take.

Before taking Clomid, your doctor should perform a gynecological examination before you start taking the drug. This is necessary in order to ensure that there are no physical conditions that could prevent you from becoming pregnant or that could indicate that Clomid is not the right remedy for you.

Do not take Clomid if you are allergic to any of the ingredients of the drug. Also, do not take Clomid if you are pregnant.

To avoid accidental ingestion in the early stages of pregnancy, you should perform tests during each treatment cycle to determine if ovulation is occurring. You should have a pregnancy test before starting your next course of Clomid therapy.

Tell your doctor immediately if you notice the following side effects:

• nausea or vomiting;
• breast discomfort;
• headache
• insomnia, nervousness, depression, fatigue, dizziness, or delirium
• rash or skin irritation;
• increased frequency of urination;
• hair loss;
• fever;
• vaginal discharge;
• seizures;
• vision problems;
• increased heart rate;
• heartbeat;

In general, the drug is absolutely safe. We wish you good health and a successful conception of the child, even if you are currently experiencing difficulties with conception!

So, how to stimulate ovulation? Problems of the reproductive system of the female body, as you know, can sometimes be solved without surgical intervention. It is enough just to go to the pharmacy for the “magic” pills prescribed by the doctor the day before. And, while your eyes are scattered when choosing medicines, we will help you understand the principle of the most popular of them, and what is the effect of each.

How to stimulate ovulation: Clomid.

Clomid was originally developed as a pilot version of a universal drug for breast cancer, but, failing to meet high expectations, began to be used as a drug to stimulate ovulation among women who want to become pregnant. So, clomid can be recommended by doctors in three cases:

1. If the absence of ovulation is caused by a previously diagnosed polycystic ovary syndrome.
2. If infertility does not have a certain genesis, that is, with ideal medical indicators, a woman still does not get pregnant after more than a year of intensive attempts. In this case, clomid is usually used in conjunction with another drug – metformin, which, in turn, increases the level of insulin and promotes ovulation.
3. If in vitro fertilization (IVF, ICSI, etc. ) requires additional guarantees of the success of the procedure. Although from a medical point of view, this use of clomid is not sufficiently justified, many patients personally ask their doctor to include clomid in their treatment course, since this drug is considered effective when it comes to increasing the chances of becoming pregnant.

Studies and many years of experience show that about 80% of women who have problems with ovulation, observe the release of an egg from the ovaries after the first application of clomid. However, only 30% of patients manage to get pregnant immediately after the first cycle. However, a six-month course of clomid use is considered quite optimal, so even if you did not manage to get pregnant after your first use, you still have a good chance of seeing the long-awaited two stripes over the next few months, provided that you follow the medication course.

The chronology of the process of using clomid is very simple. After your doctor has conducted a full medical examination and written out a prescription for the purchase of the drug, you can safely go to the pharmacy. Before use, it is necessary to consult a doctor about the interval of use, but, as a rule, clomid tablets are taken on the third to seventh day of the menstrual cycle. After a week from the beginning of the menstrual cycle, lead an active sexual life, preferably with a break interval of one day, so that your partner has time to accumulate sperm ready for fertilization. If by the tenth day of your menstrual cycle, your cervical mucus has the consistency of egg white, it means that you are on the right track, and that ovulation will occur soon. After another week or two, you can start using pregnancy tests and hope for the best.

The side effects of clomid are insignificant, and do not pose a direct threat to the female body. In the most frequent cases, abdominal pain, insomnia and weight gain are observed. The worst possible development is the appearance of ovarian cysts or the diagnosis of ovarian cancer. However, the chance of such consequences appearing is very, very small.

The duration of the female cycle varies. The most common cycle duration is between 23 and 35 days. The difference in the length of the menstrual cycles, as a rule, concerns the period before ovulation (the so-called follicular or follicular phase). In most women, from ovulation (when the egg comes out of the ovary) to the beginning of menstruation, it takes from 12 to 16 days (the so-called luteal phase).

Phases of the menstrual cycles

Menstruation: The first day of the menstrual cycles is the first day of menstruation (day 1). Menstruation then lasts from 3 to 7 days. Surely, you know that in the presence of menstrual pain, the most severe pain you experience in the first few days of menstruation. This is because your hormones actively promote the rejection of the uterine mucosa that has grown during the previous menstrual cycle.

Preparing for ovulation: At the beginning of your cycle, the pituitary gland, located at the base of the brain, produces follicle-stimulating hormone (FSH). This is the main hormone that stimulates the ovaries to produce eggs. Follicles are fluid-filled vesicles in the ovaries. Each follicle contains an immature egg. FSH promotes the maturation of a certain number of follicles and the production of the hormone estrogen. On the first day of menstruation, the estrogen content is at its lowest level. Then it begins to rise along with the maturation of the follicles.

As the follicles develop, usually one of them becomes “dominant”, and in this large follicle the egg matures. At the same time, the growing level of estrogen in the body is responsible for saturating the lining of the uterine cavity with nutrients and blood. This is so that in the event of pregnancy, the fertilized egg will have all the nutrients and support needed for growth. High levels of estrogen also contribute to the formation of mucus, a “sperm-friendly” environment (or scientifically, cervical (cervical) mucus of the fertile phase). Perhaps you have paid attention to not thick sticky discharge, which may have a cloudy whitish hue. Spermatozoa move more easily through this mucus and survive for several days.

Understanding the ovulation cycle

Ovulation: The level of estrogen in the body is steadily increasing, and at some point it leads to a sharp increase in the level of luteinizing hormone (ovulatory surge of LH). The surge of LH leads to the rupture of the dominant follicle and the release of a mature egg from it, which then enters the fallopian tube. This process is called ovulation.

Many women believe that ovulation occurs on day 14, but 14 days is the average, and most women usually ovulate on another day of the menstrual cycle. The day of ovulation differs from cycle to cycle. Some women claim to experience a pain spasm during ovulation, but most women do not feel anything, and ovulation passes without any signs.

After ovulation: After release, the egg moves along the fallopian tube towards the uterus. Its life cycle is up to 24 hours. The life cycle of the sperm is more variable, however, and is usually between 3 and 5 days. Thus, the days immediately preceding ovulation and the day of ovulation itself are the most fertile – it is then that you have the greatest chance of becoming pregnant. Immediately after ovulation, the follicle begins to produce another hormone – progesterone.

Progesterone contributes to the subsequent preparation of the uterine mucosa for the reception of a fertilized egg. Meanwhile, the empty follicle in the ovary begins to shrink, but it continues to produce progesterone and begins to produce estrogen. During this time, you may experience premenstrual tension syndrome (PMS), such as breast soreness, bloating, drowsiness, depression, and irritability.

When using assisted reproductive technologies (ART), as a rule, hormonal drugs (IVF pills) are used. IVF preparations are chemical compounds obtained synthetically, which have the same effect on the body as their own sex hormones.

The drugs are used at the stage of ovulation stimulation, to prepare the endometrium for embryo transfer, as well as to support the luteal phase in early pregnancy.

Below we will look at these medications, but the information on them is in no way a prescription and can not be used by patients on their own without the appointment of the attending physician. Our article is for informational purposes only.

Preparations for ovulation stimulation

Antiestrogens

Clomid (clomiphene, clomiphene citrate, clostylbegite). It is available in tablets of 50 mg. In small doses, it increases the secretion of gonadotropins (prolactin, FSH and LH), stimulates ovulation; in high doses, it inhibits the secretion of gonadotropins. It is used both to stimulate ovulation under the control of ultrasound, and in IVF protocols.

Human Menopausal Gonadotropins

IVF pills: Menopur containing 75ED FSH and 75ED LH (Ferring, Germany). Currently, there is a Menopur-Multidose containing 1200 units of FSH and 1200 UNITS of LC, with the ability to dose the drug using a convenient handle.

Menogon containing 75ED FSH and 75ED LH (Ferring, Germany).

Alterpur-urofollitropin (FSH) , available in doses of 75 and 150 IU; (Ibsa, Switzerland). e

Merional (Ibsa, Switzerland), The ratio of the biological activity of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) is 1:1. It is available in a dose of 75ME and 150ME (the dose is measured by FSH).

Bravel (Ferring, Germany) – urofollitropin (a highly purified follicle-stimulating hormone), is available in a dose of 75 MG FSH.

Previously existing menotropins-Pergonal, Metropin, Humegon – are not currently produced.

The use of estrogens in ART

Estrogens in transdermal (through the skin) or oral (through the mouth) forms are used:

• in programs using cryopreserved embryos
• in protocols of superovulation stimulation
• in patients with endometrial hyperplasia in surrogacy programs.

IVF pills: Proginova 2 mg (Delfarm, France) – dragee for oral administration.

Estrofem 2 mg (NOVO NORDISK, Denmark) – tablets for oral administration.

Divigel 0.5 and 1.0 (Orion Corporation, Finland) – gel for external use in single-dose packages.

Estrogel 2.5 mg (Besins, Belgium) – gel for external use, contains 1.5 mg of estradiol in tubes of 80 g with a measuring spatula.

The Council of Experts of the RARCH (Russian Association of Human Reproduction) recommends continuing estrogen therapy during the first trimester of pregnancy in the absence of their own yellow body, its functional insufficiency or endometrial hypoplasia.

When making a list of drugs that we use in our work, you can not choose the best one or make a universal scheme of stimulation. Depending on the clinical situation, the doctor individually selects the drug and its required dose.

! Attention ! All information on the drugs presented in this article is not intended as a prescription and cannot be used by patients independently without the appointment of the attending physician. The article is for informational purposes only.

Most likely, you have at least one friend who, after getting pregnant, said: “It happened at the exact moment when I stopped thinking about it.” It’s annoying, frustrating, and nerve-wracking, especially when all you want is to have a baby. What prevents you from getting pregnant?

It seems that nothing will work-but your friend is telling the truth. Stress can be one of the main reasons why you can’t get pregnant: high levels of the stress hormone cortisol can negatively affect fertility.

A study of American scientists who followed 400 couples trying to get pregnant found that women with high levels of alpha-amylase (a stress indicator) were 29% less likely to get pregnant than women with a normal indicator.

Experts say that constant stress reduces the production of hormones responsible for a stable cycle.

Relax and try to let go of the situation for a while. Learn to meditate, sign up for yoga.

Mistake #2: Doing too much/not enough

If you’re going to do it – do it right! Many couples believe that if you” save ” sperm and do not have sex for a week, the chances of conception will increase significantly. This is not true. After about a week of abstinence, sperm motility decreases markedly.

For successful conception, doctors recommend having sex every day or every other day for a week before and including the day of ovulation. More frequent sex can negatively affect the ability of sperm to fertilize, and if you do it less often – you can skip the window of conception.

So, if your sex life has long been not as stormy as at the beginning of the relationship, this is a good reason to diversify it.

It would seem that the 21st century is in the yard, but many women still continue to believe in the miraculous power of douching. It seems that everything is logical: with any infection, improper nutrition, the presence of bad habits, the environment in the vagina becomes acidic.

Sperm in such an environment dies and cannot fertilize the egg, so many people use a weak solution of soda to make the environment alkaline and create favorable conditions for conception. But doctors are opposed to this method: soda kills not only harmful microorganisms, but also useful ones, thus violating the natural pH of the vagina.

In addition, douching with soda can exacerbate inflammatory processes and diseases such as erosion and damage to the cervix, which a woman often does not know about without visiting a gynecologist.

If the attempt to get pregnant fails, remember that you can use, for example, clomid, taking it, you increase your chances of pregnancy.

Trying to get pregnant: Don’t blame yourself

Speaking about infertility, we usually believe that the problem is on the part of the woman. But in reality, the responsibility lies equally with both partners.

Doctors say that in 40% of cases of infertility, the cause should be sought from the man, and in another 40% – from the woman. The remaining 20% is compatibility, a combination of both partners. But don’t panic too soon.

Remember that a healthy couple needs from 6 months to a year to successfully conceive.

The most common mistake is the wrong definition of the day of ovulation. In most women, it occurs in the middle of the cycle, but this applies to women with a 28-32-day cycle. Ovulation usually occurs 14 days before the start of menstruation. Therefore, if you have a 24-day cycle, then ovulation will occur on day 10.

If your cycle is noticeably longer, say 42 days, then it can be assumed that you ovulate less frequently, not in every cycle. In this case, as well as if you have an irregular cycle (in this case, ovulation can be both on day 6 and on day 21), or you do not remember when you last had your period, forget these rules.

Another mistake when trying to get pregnant

A lot has already been said on this topic, but it will not be superfluous to repeat it: it is necessary to give up bad habits at least a year before trying to get pregnant.

Why do women continue to drink alcohol and smoke, knowing how harmful this affects the ability to conceive? Doctors around the world warn: the first trimester is the most important in the formation of the child’s body. There is no amount of alcohol that is safe for him.

But some expectant mothers, drinking alcohol in the early stages, do not yet know that they are pregnant. Therefore, if you do not protect yourself, in relation to alcohol and cigarettes, act as if you are already pregnant-simply, do not use it or at least reduce it to a minimum.