Stimulation of ovulation: drugs for the procedure

What is artificial insemination?

Artificial insemination is one of the easiest to perform and long-used methods of artificial insemination, which consists in introducing sperm into the woman’s reproductive tract. The procedure involves the introduction of processed sperm from a man directly into the genital (reproductive) tract of a woman. This can be the introduction of sperm into the vagina (intravaginal insemination), or directly into the abdominal cavity (intraperitoneal insemination); These days, intrauterine insemination is the most common method. The first two methods are of only historical interest and, for a number of reasons, are rarely used. The effectiveness (percentage of positive results) is 20-25%, but it is still a popular and frequently used method of treating infertility.

Chorionic gonadotropin - instructions for use

This hormonal drug is obtained from the urine of pregnant women. The main pharmacological effect of recombinant human chorionic gonadotropin is stimulation of the production of sex hormones in the tissues and ovaries, ovulation, spermatogenesis, development of secondary sexual characteristics and genital organs.

In what cases is human chorionic gonadotropin prescribed? The instructions say that the drug is effective for:

• ovarian dysfunction;
• dysmenorrhea;
• anovulatory infertility;
• corpus luteum deficiency;
• threat of miscarriage;
• habitual miscarriage.

Good results are observed in cases where human chorionic gonadotropin is used in assisted reproductive techniques - there are reviews about this.

Men are also prescribed human chorionic gonadotropin for:

• hypogenitalism;
• tissue hypoplasia;
• eunuchoidism;
• cryptorchidism (undescended testicle into the scrotum);
• sexual infantilism;
• pituitary dwarfism;
• adiposogenital syndrome;
• azoospermia;
• oligoasthenospermia;
• as well as for genetic disorders.

Human chorionic gonadotropin is produced in the form of a solution (or lyophilisate for its preparation) for injection.

Advantages and disadvantages

The long history of the use of insemination (it has been in the practice of obstetricians and gynecologists for more than a dozen years) is a guarantee that the technique has been worked out to the smallest detail, and its accessibility has made it quite popular among patients.

Benefits of insemination:

• Tested and refined methodology;
• Low cost (the so-called “double insemination costs 4-6 times less than IVF with stimulation);
• Possibility of use for moderately reduced sperm fertility;
• Possibility of repetition (several attempts);
• Minimal impact on the patient’s health/well-being;
• Possibility of increasing the effectiveness of the procedure through “light stimulation”.

The method, however, is not without drawbacks:

• Low average efficiency: even when performing insemination with “light stimulation”, the probability of pregnancy after a separate procedure is low: in the best clinics it reaches 25%;
• The need for frequent monitoring of follicle/follicle growth: sometimes you have to visit the doctor up to 4-5 times before the procedure;
• Strict requirements for sperm quality: its fertility must not be lower than certain indicators: in cases with severe disorders, the technique is ineffective;
• Relative age restrictions: performing insemination on patients over 35 years of age is most often unreasonable and risks delaying the achievement of the main goal - getting pregnant;
• Despite the apparent simplicity of the technique, it nevertheless requires an equipped embryological laboratory and qualified personnel.

Side effects of the drug

Like any medicine, hCG injections have their drawbacks, which often manifest themselves in the form of complications. If used incorrectly or due to individual intolerance to the drug, the following side effects are sometimes observed:

• ascites;
• acne;
• allergic reactions;
• thromboembolism;
• polycystic disease;
• deterioration of health;
• weakness;
• digestive disorders;
• pain in the lower abdomen;
• fainting.

Indications for the procedure

Indications for insemination can be divided into two main groups:

Female factor:

• Infertility of unknown origin: examination of the couple did not reveal any abnormalities and it makes sense to start treatment in the least expensive and most simple and proven way;
• Lack of a sexual partner (for a single woman);
• Vaginismus (impossibility of sexual activity in a woman associated with involuntary spasm of the vagina);
• Cicatricial changes in the cervix (after surgical interventions) and inflammation of the cervix;
• Anomalies in the development of the reproductive organs, making independent conception problematic;
• Cervical factor infertility (also called incompatibility) is the inability of sperm to overcome cervical mucus. You can read and see more in the article:
• Some diseases/disorders of the reproductive system leading to “malfunctions” of the ovulation process: lack of estrogen up to anovulation (lack of ovulation) or other disorders, etc.

Male factor:

• Reduced ability of sperm to fertilize (fertility), in which the number of healthy (fertile) sperm under natural conditions is not enough for fertilization. In these cases, preparation of sperm in a laboratory makes the sperm fertile enough to fertilize the egg.

Main problems with the follicle

The reason for the lack of ovulation is often not only the fact that the follicle does not open, but also the fact that it does not reach the required size (does not ripen). In such cases, special drugs are first used that stimulate the growth and maturation of follicles, and only then hCG is introduced.

Before a doctor prescribes hCG to overcome infertility, a married couple must undergo examination and, possibly, additional treatment. Perhaps it won’t even come to the point of prescribing hCG injections and another treatment will be prescribed.

In most cases, patients are prescribed Clostilbegit tablets for stimulation. They can be used no more than six times in a lifetime, otherwise there is a risk of ovarian wasting syndrome. If this drug is not suitable, then choose another one. You need to take medications from days 5 to 9 of your cycle. After completion of therapy, an injection of human chorionic gonadotropin is given.

Conditions for insemination

In order to understand what prerequisites are needed to perform insemination, let’s look at how conception occurs naturally.

So, after sexual intercourse, sperm enter the vagina and begin to move “up” along the reproductive tract: through the cervix, the uterine cavity, and then, through the hole in the tubal angles, into the tubes. It is in one of the tubes that they meet the egg. The embryo formed as a result of fertilization moves towards the uterus and on the 5-6th day of development enters the uterine cavity, where the so-called. implantation (attachment to the wall of the uterus).

This means that in order for the germ cells to meet, mandatory conditions must be met: the tubes must be passable and the sperm must be sufficiently fertile (after processing). Therefore, checking the patency of the tubes and a spermogram are carried out first of all during the examination.

How does HCG injection work?

The hCG solution is administered if a follicle measuring at least two centimeters is visible on ultrasound. This substance acts on the ovulation process in a similar way to luteinizing hormone. After all, it is he who is responsible for the successful release of the egg from the ovary. Medicines based on human chorionic gonadotropin also prevent cyst formation, and during pregnancy are responsible for the development of the placenta.

When will ovulation begin after the injection?

After the injection, ovulation usually occurs within one or two days.

But this process is often delayed and takes more time. Much depends on the individual characteristics of the body, the balance of the hormonal system, the dose of the drug, etc.

In this case, ovulation began to clearly show on the test from the 3rd day after taking hCG.

Contraindications, risks and complications

Contraindications to insemination are rare, and the risk of complications is minimal. The main contraindication to insemination is the inability to carry a pregnancy to term; the list of diagnoses for which pregnancy is contraindicated is contained in the Orders of the Ministry of Health. If there are contraindications to pregnancy, insemination is not performed. A contraindication for insemination, in addition to those specified in regulatory documents, may be a proven allergy to the partner’s sperm (even after treatment!). The impossibility of insemination in the presence of vaginismus or fear is irrelevant: in such situations, the procedure is performed under intravenous anesthesia.

Extremely rare complications of insemination include the possibility of exacerbation of inflammation (adnexitis, for example), if it was not known about it in advance; in fact, a detailed examination in accordance with Order 107N, coupled with a study of the situation by the attending physician, should eliminate this kind of problem.

Diet during stimulation

During stimulation, doctors recommend following a protein diet, since protein is the building material for the embryo.

However, a strict protein diet can negatively affect kidney function, so you need to drink a lot of water while on a protein diet.

How much water? 30 ml of water x your weight is the amount of water you need to drink daily.

Before the doctor begins stimulation (induction) of ovulation, be sure to check the level of total protein (in blood biochemistry); if a decrease in protein in the body (hypoproteinemia) is detected, stimulation is not carried out, because a decrease in protein and a decrease in hemoglobin in the blood is a prognosis for the development of complications ovarian stimulation – ovarian hyperstimulation syndrome. It is better to restore the patient’s body before starting stimulation.

Preparation for the procedure

It is extremely important to undergo a detailed examination before the procedure: in Russia it is regulated by Order 107N. The examination can be done either in a antenatal clinic (clinic) or in a specialized clinic, under the supervision of a reproductologist. The second option is preferable: the specialist can ensure that, if necessary, additional studies are carried out immediately, in parallel with the main ones. Both spouses must undergo the examination; all results must be assessed by a fertility specialist. Based on the study of examination data, a diagnosis is made indicating the form of infertility (requiring treatment by insemination).

Insemination is tied to ovulation - manipulation is carried out precisely during the period of ovulation. Before the procedure, the partner donates sperm, it is processed by an embryologist (purified and concentrated) and then injected into the patient’s uterus by a fertility specialist. A long stay in the clinic's hospital is not required: we release you 30 minutes after insemination.

Diagnosis before treatment

Before you start taking medications, you need to undergo a comprehensive examination and establish an accurate diagnosis. A woman needs to undergo blood tests, have an ultrasound of the mammary glands, and check the patency of the fallopian tubes. The last point is especially important for patients with a history of abortion, curettage and inflammatory processes of the pelvic organs. This examination is mandatory for those who have used an intrauterine device for contraception. Immediately before stimulation, a study of the woman’s hormonal levels is carried out.

Stages of insemination

At the first stage, the patient undergoes monitoring of the follicle (follicles) using ultrasound in order to determine the date of expected ovulation as accurately as possible. Typically, insemination is done in a natural cycle without stimulation: to select the time of insemination, the doctor only monitors the time of ovulation without interfering with the menstrual cycle. Insemination can be carried out in a natural cycle with ovarian stimulation. The patient is prescribed gonadotropins in low doses to cause the growth of not one, but two or three follicles. In addition, to increase the likelihood of success, two procedures are often performed: immediately before ovulation (on the day of ovulation) and immediately after it (the so-called “double insemination”). To program ovulation, a trigger (a substance that ensures ovulation within a given period of time) is sometimes introduced. In this case, it is much easier to choose the time of ovulation. On the day of insemination, your spouse/partner should arrive at the clinic a little early to donate sperm an hour before insemination (processing will take about 45 minutes). 3-4 days of abstinence before sperm donation are recommended. The sperm is centrifuged and enriched with special solutions. When carrying out insemination with donor sperm, the sperm of a pre-selected donor is thawed an hour before the manipulation, its condition is checked, and then insemination is carried out.

Intrauterine insemination is usually performed in the operating room. The patient is hospitalized in the day hospital 30-40 minutes before the procedure. The procedure is painless, but occasionally it must be performed under intravenous anesthesia.

Under ultrasound control, treated sperm is injected into the uterine cavity closer to the bottom. After the procedure, we ask the patient to stay in the operating room for 5-10 minutes, lie on the side that corresponds to the side of ovulation (for example, if ovulation is expected in the right ovary, then on the right side), then you can get up. There is no need to stay in a medical facility, but in our clinic the patient will be offered tea with sweets; so that she can relax and put her thoughts in order, because there is a two-week wait for the result! Often, such a half-hour “time out” is quite enough to create a positive attitude!

The sensations after insemination are quite normal: you should not expect any changes. There is no discomfort or pain.

This is how both “single” insemination takes place (when insemination is carried out immediately after ovulation) and double insemination.

Why take hormones during stimulation?

Monitoring blood hormones during stimulation helps the doctor monitor the functioning of the ovaries, cancel stimulation in time, and choose a drug for ovulation.

Usually, on the 2-3rd day of the menstrual cycle, LH, Progesterone and Estradiol are monitored, during stimulation of ovulation Estradiol, on the day of giving the ovulatory dose (ovulation trigger) Progesterone, LH, Estradiol.

After diagnosing pregnancy, in order to correct pregnancy support, the doctor can monitor the level of Progesterone and Estradiol levels