There are two misunderstandings about the use of ovulation induction drugs: one is too careless and use them casually; the other is too cautious, because there is a need but you can\’t make up your mind to use it.
We often see some women, in order to pursue twins, even if their ovulation function is good, they still take it from time to time and pray for the miracle of multiple births. On the contrary, some women have ovulation disorders themselves. They should follow the doctor\’s advice and use ovulation-stimulating drugs in a timely manner to strive for early pregnancy. However, they have too many doubts and are afraid of this and that, which delays the best time to get pregnant. .
These misunderstandings in use are caused by a lack of understanding of the working principles and side effects of ovulation induction drugs. I think that only by fully understanding ovulation induction drugs can we have the correct attitude.
Now I will try to introduce ovulation induction drugs in detail.
We must first understand how normal endocrine regulation occurs.
◎ The first step: the hypothalamus secretes two hormones: follicle-stimulating hormone-releasing hormone (FSH-RH) and luteinizing hormone-releasing hormone (LH-RH);
◎ Second Step: Under the action of the above two hormones, the pituitary gland releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH);
◎ Step 3: Under the action of FSH and LH, the ovary The follicles mature and are discharged to form the corpus luteum, which produces estrogen and progesterone;
◎ Step 4: Estrogen and progesterone feed back to the hypothalamus to inhibit the release of the two gonadotropins secreted by the hypothalamus hormone.
This is a cyclic circle, and their cyclic process is A-B-C-A. It is very precise to form such a circulation circle to regulate endocrine. Every link can be closely linked with each other. Normal endocrine system is just because every link is closely linked with each other. So as long as one of the links goes wrong or is affected by the outside world, the entire circulatory system will be disordered. For example, emotional anxiety will immediately affect the hypothalamus, which in turn affects the production of other hormones. Therefore, endocrine disorders are very common in women. Typical ovulation disorders such as polycystic ovary syndrome and luteinization syndrome of follicles are common. Retarded follicular development or follicle atrophy midway are also often seen. If ovulation disorder only occurs once in a while, it is not a serious problem. If ovulation disorder exists for a long time, artificial intervention should be carried out, otherwise it will cause infertility.
When you are diagnosed with ovulation disorder, you should treat it as soon as possible. If it cannot be treated, drugs should be used to induce ovulation as soon as possible. You know, womenOvarian function declines with age.
Among the drugs that induce ovulation, the most commonly used and representative one is clomid. Many people think that taking clomid will affect future children, but in fact it will not. Clomid acts on the hypothalamus, which is the headquarters of the entire system. Under the influence of clomiphene, the headquarters issues an order to the subordinate organ, the pituitary gland, and then the pituitary gland releases FSH and LH to the basic unit, the ovary, to promote the development of follicles in the ovary.
During the entire process, the development of follicles is not prompted by external drugs. It grows under the action of FSH and LH produced by itself, so there is nothing abnormal. This is like promoting a manager in a grassroots unit. It is a decision made by the board of directors, and documents and notifications are issued at all levels. The procedures are completely normal and legal. Clomid only affects everyone\’s opinions in the board of directors. Therefore, taking Clomid will not have any impact on future children. Children will be equally smart and smart whether they take it or not.
The treatment method of clomiphene is as follows: in the first month of treatment, on days 5 to 9 of the cycle, 50 mg is administered daily, and then increased by 50 mg in each cycle to 200 mg per day. ~250 mg maximum until ovulation. Note that before inducing ovulation, semen analysis and hysterosalpingography are also required. It is only meaningful to induce ovulation when it is clear that these two indicators of the couple are normal.
After using clomiphene, follicles will usually mature. When the follicles grow to about 20 mm, intramuscular injection of 10,000 international units of HCG will cause a sudden increase in hormones to promote ovulation.
After ovulation, the basal body temperature will increase by 0.3 to 0.5°C, the serum progesterone level will rise to above 3ng/ml, and the endometrium will become secretory.
In general, clomiphene can effectively induce ovulation, and its success rate in inducing ovulation is about 80%. Although 80% of women treated with clomiphene can ovulate, only 40% can become pregnant. The inability to become pregnant is mainly due to the fact that other fertility factors in women who do not ovulate are often abnormal.
When inducing ovulation, doctors sometimes ignore the estrogen levels of those being treated. It is important to know that clomiphene only works under a certain estrogen level. The baseline level of estradiol must be greater than or equal to 100pg/ml, which can cause the rapid expansion of a single dominant follicle, otherwise it will lead to failure. Therefore, an experienced doctor must know your estrogen level and prescribe estrogen medicines to be taken at the same time.
In the process of IVF, in order to obtain multiple qualified follicles, the doctor will test your follicle development throughout the process (every day), and constantly adjust the type and amount of medication according to the serum estrogen level. In patients whose estradiol levels do not rise significantly, or even fall in the final stages of treatment, doctors will postpone ovulation induction treatment for one cycle.
Women should pay attention to their estrogen levels at all times. If the ovaries produce estrogen,Poor hormonal capacity can lead to estrogen deficiency syndrome, so in the process of treating anovulation, for patients with ovarian failure, the main problem is to solve the problem of estrogen deficiency; for another type of patient with low estrogen levels, patients with hypothalamic type The same goes for women who don\’t ovulate. If fertility is not desired, estrogen replacement therapy may be considered.
So I have always advocated that women should regulate their estrogen levels in daily life. Drinking soy milk every day is a good way. Soy isoflavones are phytoestrogens, which can solve many problems caused by low estrogen. and female patients who do not ovulate.
I have fully emphasized the importance of estrogen, because when estrogen is above a certain level, follicles can roughly develop to maturity, and then use drugs to induce ovulation, the effect is very good; on the contrary, when estrogen levels are low , follicles are underdeveloped, and it is often difficult to use general drugs to induce ovulation.
So, sisters must remember that they should use low doses of diethylstilbestrol (or other estrogen drugs) two menstrual cycles before using drugs to induce ovulation. Some patients can even ovulate naturally using this method alone. In the remaining patients, medications can be used to induce ovulation after estrogen levels rise. Of course, clomiphene and estrogen can also be used together, but one thing to note with this method is that clomiphene and estrogen cannot be taken at the same time. Clomiphene should be taken first, and then estrogen. Because estrogen can inhibit the anti-estrogenic effect of clomiphene and thus reduce its efficacy, adding estrogen after taking clomiphene can improve the penetration of sperm by cervical mucus, thereby increasing the pregnancy rate.
Here, I would like to mention a phenomenon – \”clomiphene rebound\”, that is, the phenomenon of not getting pregnant during the month of taking clomiphene, but unexpectedly getting pregnant after stopping the drug for a period of time. This phenomenon This phenomenon often occurs clinically, mainly because during the process of ovulation induction, the patient\’s mental state is too tense, which affects the discharge of follicles, the normal peristalsis of the fallopian tube, and the combination of sperm and eggs. When the ovulation stimulation was stopped, the patient relaxed and became pregnant smoothly. After the use of clomiphene to induce ovulation fails, a further method is to use human menopausal gonadotropin-HMG. HMG is composed of equal amounts of FSH and LH. It does not act on the hypothalamus, but directly acts on the ovaries.
Compared with clomiphene, it has three advantages: (1) It is more likely to cause ovarian response; (2) It does not produce anti-estrogenic effects; (3) It can produce multiple preovulatory follicles. Of course, it also has disadvantages, that is, it is relatively expensive and requires frequent monitoring of the status of the ovaries.
HMG must be used early in the menstrual cycle (before the dominant follicle appears) in order for the drug to be most effective. The dosage of administration is not certain, usually 2 to 4 ampoules are injected every day. When the follicles reach maturity and are close to ovulation and luteinization, 5000 to 10000 international units of HCG are injected in a timely manner.
HMG can be used alone or in combination with clomiphene. jointThe course of treatment used is as follows: take clomiphene for 5 days starting from the 5th day of menstruation, then use 75 to 150 units of HMG after stopping clomiphene, and adjust the dose according to B-ultrasound monitoring of follicle development until the follicle diameter is greater than or equal to 18 mm is disabled. 24 hours after stopping HMG, inject 5,000 to 10,000 international units of HCG to promote ovulation of follicles. At this time, you need to accurately grasp the time of intercourse. The most likely time for ovulation is 24 to 36 hours after HCG injection.
What needs to be emphasized here is that inducing ovulation is a good method for women with ovulation disorders. However, if your ovulation function is normal, then you must not blindly take ovulation induction for the purpose of having multiple babies. Ovulation medications. Because any method is actually a double-edged sword, with advantages and disadvantages.
As we all know, unruptured follicle luteinization syndrome is a condition in which follicles continue to grow but do not ovulate. The probability of this symptom appearing during the induction of ovulation is quite high, even if HCG is injected. It is useless to use exogenous hormone peak. If you use it too much, it will affect the formation of your endogenous LH peak and cause endocrine disorders. Especially when using HMG, estrogen levels will gradually increase. After using HCG, estrogen levels will further increase. When serum estradiol levels are too high, there is a risk of severe ovarian hyperstimulation syndrome. . Severe cases may endanger the patient\’s life and require hospitalization for observation.
This article is provided by Baidu Reading and is excerpted from \”Pregnancy Can Be Simple\” Author: Feifei Mom