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The EmbryLife Center offers a whole range of services for diagnostics and treatment of both female and male infertility. Our specialists use American IVF technology: we work according to guidelines that have shown proven results in thousands of US patients. This technology has implicit excellent laboratory equipment capabilities, in strict compliance with ASRM (American Society for Reproductive Medicine) and ESHRE (European Society of Human Reproduction and Embryology) requirements.

EmbryLife is the only clinic in Russia that has been accredited by the American Association of Embryologists.

(812) 327-50-50

35 Sadovaya St., St. Petersburg, Russia

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Induction of ovulation and superovulation


Indications: anovulation that may be associated with ovarian insufficiency or as a phase of preparation for IVF or delayed motherhood.

  • Ovulation induction is performed with hormonal drugs, with ultrasound monitoring of follicular growth and development in the ovaries. Following the induction of ovulation, it is possible to get pregnant either naturally or with the use of AI (artificial insemination).
  • The induction of superovulation is performed with hormonal drugs, with ultrasound monitoring of follicular growth in the ovaries, which is followed by retrieval of the follicles for IVF and freezing.

Embrylife

Types of hormonal stimulation protocols

There are many modifications (protocols) of hormonal stimulation that are selected based on the age, diagnosis and other peculiarities of the woman. In most cases, at least two hormones are used:

  • FSH for follicle maturation
  • CG for egg maturation induction.
  • Several other hormones preventing premature ovulation, and progesterone necessary for maintaining the pregnancy may also be used.

Although all the IVF patients produce their own progesterone, according to the studies, the probability of getting pregnant still increases if artificial progesterone is added. Several protocol types are used in IVF practice, which is related to the availability of various modern drugs. The protocols differ in treatment duration and hormonal drugs used for stimulating the production of a larger number of ova. Listed below are some of the protocols.

Long-term protocol of superovulation induction with GNRH agonist.

Induction of ovulation and superovulation

The agonists of gonadotropin-releasing hormone, GnRH-a, represent a class of drugs that lead to pituitary desensitization to regulatory influence following use within several days. Pituitary desensitization prevents this organ from responding to the growing estradiol level in the course of follicular growth stimulation with gonadotropin preparations. The GnRH-a preparations are administered from the menstrual cycle 21th day, which inhibits the secretion of endogenous gonadotropins (FSH, LG) and estrogens and blocks spontaneous ovulation (decapeptyl 0.05 mg). Gonadotropic stimulation is started when pituitary desensitization is reached, which usually occurs 10 days after initiation of GnRH-a administration, is manifest as a decrease in the blood estradiol level < 50 pg/ml and coincides with the menstrual cycle beginning.

Long-term protocol with prior use of oral contraceptives.

This protocol is used in women with an irregular menstrual cycle. It enables prevention of retention structures forming during superovulation induction. Oral (single-phase) contraceptives are administered for 21 days, in the menstrual cycle preceding superovulation induction. The administration of GnRH-a is started the next day following withdrawal of the contraceptives and continued until the HCG initiation day. Gonadotropic stimulation starts from the first to third day of the next menstrual cycle.

Super long-term protocol

The super long-term protocol is used in patients with endometriosis and uterine myoma. Depot preparations of GnRH-a are administered for 3 to 6 months preceding superovulation induction. Gonadotropic stimulation is performed during the last month of GnRH-a administration.

Short-term protocol

The short-term protocol is used for obtaining the maximum possible follicle count in women with insufficient ovarian response. To inhibit spontaneous ovulation, either GNRH agonists may be administered daily from the menstrual cycle 1st or 2nd day, or antagonists may be administered from the menstrual cycle 5th or 6th day. Gonadotropic stimulation starts from the first to third day of the menstrual cycle. The drugs of these groups are administered until the day of HCG initiation.

Short-term protocol with prior use of oral contraceptives.

Oral (single-phase) contraceptives are administered for 21 days, in the menstrual cycle preceding superovulation induction. The administration of GnRH-a is started after withdrawal of the contraceptives, from the menstrual cycle first day and continued until the HCG initiation day. Gonadotropic stimulation starts from the first to third day of the next menstrual cycle. This protocol is used in women with an irregular menstrual cycle and the risk of insufficient response to superovulation induction.

Conservative protocol.

The conservative protocol involves conservative ovarian stimulation with low doses of gonadotropins. The protocol is aimed at obtaining a relatively small number of ova (1-5) that are, however, of good quality and suitable for fertilization and embryonal development, in patients with depleted follicular reserve of the ovaries. The protocol involves freezing the ova, therefore, it is very important to use only up-to-date cryo-preservation methods that enable preservation of most of the precious ova.  The EmbryLife Center only uses up-to-date cryo-preservation methods. Our specialists have mastered the method of vitrification (quick freezing) and can guarantee high embryonal survival after thawing. This reduces the risk of severe hyperstimulation syndrome and improves the implantation conditions for embryos transferred into the uterine cavity, so we can provide a conservative method of subsequent IVF cycles for the woman.

Monitoring of follicular development and the endometrium.

Induction of superovulation (ISO) would be impossible and dangerous without thorough monitoring of the uterine and ovarian processes. ISO involves U/S and hormonal monitoring. Monitoring makes it possible to determine the time for starting gonadotropic stimulation, assess the ovarian response and endometrial conditions, control the effectiveness of stimulation and adjust the regimen and doses of the drugs used, predict and prevent Ovarian HyperStimulation Syndrome. The most important task of the monitoring is determining the time for HCG administration. U/S and hormonal monitoring starts from the menstrual cycle 2nd day, then tests are conducted on the 5th to 7th day of hormonal stimulation, and after that, on an individual basis.

An experienced physician will take into account the woman’s ovarian reserve and predict how the patient’s body may respond, which will serve as the basis for selecting a relevant protocol. Indicators of completion of superovulation induction: endometrial thickness of at least 9 mm, multilayered endometrial structure and presence of follicles with a diameter of at least 17 mm. To complete oocyte maturation, chorionic gonadotropin (CG) preparations - pregnyl, ovitrelle and choragon are prescribed.

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