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Fertility drugs used to superovulate the ovaries by causing the production of numerous follicles may be given in a variety of combinations, which are called protocols. Lupron: a gonadotropin-releasing hormone (GnRH) antagonist, which acts on the pituitary gland to inhibit gonadotropin (FSH and LH) secretion and prevent premature ovulation. In order to optimize the stimulation of the ovaries, a fertility drug called Lupron is given starting one week before the expected period, on cycle day 21 of a 28-day cycle. By suppressing these two hormones (follicle stimulating hormone (FSH) and luteinizing hormone (LH)), the ovaries should be quiet. Lupron is administered subcutaneously, meaning underneath the skin and not into the muscle. Ganirelix and Cetrotide are both gonadotropin releasing hormone (GnRH) antagonists that suppress the pituitary glanda€™s LH secretion by binding to the GnRH receptor. Ganirelix Acetate or Cetrotide is usually started after ovarian stimulation has begun, typically around stimulation day 6, or when the lead follicles are approaching 12 mm in mean diameter.
After ovarian suppression has been achieved, ovarian stimulation using gonadotropin fertility drugs may commence at a scheduled time, which is referred to as the cycle start. The dose of gonadotropins will be based upon age, weight, number of follicles, cycle day 3 FSH and estradiol levels, and the response to previous stimulation cycles. When the follicles have met the criteria that indicate the eggs are mature, patients are instructed to administer hCG (Pregnyl or Ovidrel). Ovulation treatment India offers information on Ovulation Doctor India, Ovulation treatment Hospital India, Ovulation treatment Abroad, Ovulation problem causes, symptoms, Risk factors, treatment.
Ovulation induction is a form of treatment which involves stimulation of the ovaries to bring about development of a ripened egg which can then be fertilised by a normal act of intercourse. The second use of ovulation induction was to increase the number of eggs reaching maturity in a single cycle to increase chances for conception. Figure is about Ultrasound picture of a polycystic ovary from a woman with PCOS - polycystic ovarian disease.
The four major types of drug therapy for ovulation problems include Clomid (Serophene, clomiphene citrate), injectable gonadotropins, GnRH pump, and bromocriptine.
Ovulation induction, in ovulatory women, is always combined with intrauterine insemination. A careful selection of treatment regimens combined with diligent monitoring can bring excellent results.
Success rates for induction of ovulation vary considerably and depend on the age of the woman, the type of medication used, whether there are other infertility factors present in the couple, etc..
Ovulation induction is a term that refers to the administration of medication to stimulate ovulation. Estradiol Levels - Estradiol is released into the blood by the growing follicles as they respond to medications. Vaginal ultrasounds - Vaginal ultrasounds can visualize the number of developing eggs and measure their size and growth. Early in the stimulation cycle we measure estradiol levels and perform vaginal ultrasounds every couple of days to assess growth.

Ovulation induction cycles are usually followed by the administration of human chorionic gonadotropin (hCG), an injection to induce ovulation. Perhaps the most significant risks of using injectable gonadotropins are multiple gestation and ovarian hyperstimulation. Ovarian hyperstimulation is also a possible side effect of ovulation induction and typically occurs 5-7 days after hCG injection. Ganirelix is a GnRH agonist and may be used instead of Lupron to control ovulation timing. Alternately, if instructed to initiate oral contraceptive pills (OCPs), then Lupron is administered beginning on day 14.
The clinic should be notified when the period starts so that a baseline ultrasound and blood estradiol test can be scheduled. In approximately 10 to 15 percent of patients, one or both of these conditions are not met. These gonadotropin fertility drugs are continued throughout the stimulation phase of the cycle, that is, until hCG is administered. The initial dose of medication will be taken for 2-3 days before returning to the clinic in the morning for an estradiol blood test.
In general, at least two follicles with a mean diameter of at least 18 mm and an appropriate estradiol level must be present before hCG is administered.
The purpose of this medicine is to induce the final stages of oocyte maturation and the release of the eggs by the ovary. The initial agents for this treatment (used first for IVF and only later for simpler treatments) were injectable medications.
For women with ovarian failure or extremely very poor quality eggs there is not currently any drug available to allow a reasonable chance of conception with any type of ovarian stimulation. The picture on the upper left shows multiple eggs developing on the ovary and the picture on the bottom right shows good endometrial development (the inside of the uterus).
Towards the end of the cycle we perform these assessments more frequently to control the timing factors that will maximize the chances of becoming pregnant and minimize side effects. Intrauterine inseminations are performed 30 to 40 hours after the hCG injection which is just prior to ovulation. Ovulation induction can have up to a 20% incidence of multiple gestation (more than one fetus). Please note that the number of patients in the 40 years of age and older group is small and therefore the pregnancy rate may not be accurate for a larger group of patients. The following information describes the standard or initial protocol used for the majority of patients.
Lupron acts by suppressing two hormones made in the pituitary gland, which normally cause the ovary to develop follicles and release eggs. Down regulation or ovarian suppression with Lupron allows the physician to have greater control over ovarian stimulation, which provides for an even growth of ovarian follicles and prevents a condition known as premature luteinization.
Lupron is usually given 10 to 14 days before ovarian suppression occurs, but may also be given earlier without affecting the ovarian stimulation.

The purpose of these tests is to confirm that the Lupron has successfully suppressed the ovaries to a baseline state.
Depending upon the results of these tests, the Lupron medication may be extended for another week and the patient may be asked to return for another sonogram and blood estradiol test. Usually 5,000 to 10,000 units of hCG will be injected 36 hours before the planned oocyte retrieval. These agents carry an increased risk of multiple gestation, ovarian hyperstimulation, and increased cost and time commitment.
If you do not ovulate, or you ovulate and do not become pregnant after clomiphene therapy, other medications may be prescribed either alone or in combination.
Egg donation is the only realistic option for getting pregnant with premature ovarian failure. Gonadotropins are injectable ovulation stimulating hormones that are identical to the hormones secreted by the body. Letrozole is typically used alone or in conjunction with injectable gonadotropins to help stimulate the ovaries. The most commonly used gonadotropin for ovulation induction at Natural Cycle Fertility is human menopausal gonadotropin (hMG) which contains both Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Intrauterine inseminations use specially prepared and concentrated sperm, which helps to maximize the number of sperm available for fertilization.
The majority of these pregnancies are twins, however, more than two fetuses can sometimes develop.
Approximately 10 percent of patients require longer than 10 to 14 days of Lupron to completely suppress the ovaries. Medication will usually be taken for two more days before for another estradiol blood test.
In general, the symptoms associated with ovarian hyperstimulation are mild and may include lower abdominal pain, heaviness and bloating. The Lupron dose will typically be reduced by half once the stimulation phase of the cycle begins. They replace natural follicle stimulating hormone (FSH) and, if they are successful, the ovaries produce multiple follicles and high quality, mature eggs. It is extremely uncommon for hyperstimulation to result in any severe medical problems or hospitalizations. Timed intercourse will be suggested so that sperm will be present when the egg is released from the follicle, in order for fertilization to take place in the fallopian tube.

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