What are the precautions while taking ovulation-stimulating drugs?

Taking ovulation-stimulating drugs is a method of promoting ovulation. Ovulation-stimulating drugs should not be taken indiscriminately, otherwise not only the ovulation-stimulating effect will not be achieved, but also the health of women will be harmed. Women who are preparing for ovulation promotion must take ovulation-stimulating drugs under the doctor's orders, and should not use drugs indiscriminately to promote ovulation. For those who do not know what precautions should be taken while taking ovulation-stimulating drugs, you can learn in detail below. What precautions should be taken while taking ovulation-stimulating drugs? Let’s take a look at it next.

1. Clomiphene (CC)

It is the first choice drug for inducing ovulation and the most well-known in China. It is also commonly known as "duozai pills". It is mainly suitable for women with anovulatory infertility with a certain level of estrogen in their bodies, infertility caused by PCOS and corpus luteum insufficiency, etc., but not suitable for infertility caused by high prolactin.

Generally, starting from the 5th day of menstruation, take 50-150 mg/day orally for 5 consecutive days. Ovulation may occur 5-11 days after stopping the drug. If the patient is amenorrhea, progesterone should be taken starting on the 5th day of withdrawal bleeding. If the patient ovulates but does not conceive after treatment, the original treatment can be repeated for 3-4 courses. Its main side effects include: vasomotor flushing, ovarian enlargement, abdominal discomfort, and rarely blurred vision, nausea, vomiting, headache, fatigue, etc.

Because clomiphene has anti-estrogenic activity, excessively increasing the dosage or prolonging the use time can cause the endometrium to become thinner, the cervical mucus to become thicker, reduce the receptivity of the embryo or increase the rate of spontaneous abortion, so estrogen can be appropriately added to improve the endometrium. If the estrogen level is low, a small dose of estrogen can be used first for 1 to 3 cycles to increase the sensitivity of the hypothalamus to clomiphene.

2. Human menopausal gonadotropin

Each vial contains 75U of FSH and LH, and is suitable for hypothalamic-pituitary anovulation or low gonadotropin. However, because it contains LH, it is not suitable for ovulation induction in patients with high LH levels. Starting from the 5th day of menstruation, 75-225U per day are injected intramuscularly until the diameter of the follicle reaches 18mm. Its biggest advantage over clomiphene is that it increases estrogen levels and promotes endometrial proliferation.

3. Follicle-stimulating hormone, luteinizing hormone-releasing hormone

Suitable for anovulators with insufficient hypothalamic secretion. FSH is injected intramuscularly or subcutaneously at a rate of 75-225 U daily starting from the 5th day of menstruation, and HCG is used to induce ovulation at the right time. LH is injected intravenously by micropump pulses, with a pulse interval of 90 to 120 minutes, a small dose of 1 to 5 μg/pulse, a large dose of 10 to 20 μg/pulse, and the medication is used for 17 to 20 days, or 50 μg is injected intramuscularly daily starting from the 5th day of the menstrual cycle for 7 to 10 consecutive days.

(4) Human chorionic gonadotropin (HCG): It is highly similar to LH. After other ovulation-inducing drugs are used to mature the follicles (follicle diameter > 18 mm, E2 > 200 pg/ml), a large dose (5000-10000 U) can be injected intramuscularly to induce ovulation. If ovulation does not occur, it can be repeated after 36 hours. The benefit is that it helps support corpus luteum function.

(5) Gonadotropin-releasing hormone and its analogs (GnRH, GnRH-a, GnRH-ant): The disadvantages are that the medication time is long and the cost is high. Gonadotropin-releasing hormone (GnRH) can be administered using a pulse pump, resulting in the release of FSH and LH, and is suitable for hypothalamic amenorrhea. Gonadotropin-releasing hormone agonist (GnRH-a): a commonly used drug mainly used in controlled ovulation in assisted reproduction, such as Noradrenaline, Dabijia, Diphereline, Enanton, etc. It is often used to downregulate during ovulation induction. Gonadotropin-releasing hormone antagonists (GnRH-ant) are rarely used. When the follicle diameter reaches 14 mm or on the 6th day of Gn, the antagonist is started until the day of HCG injection.

6. Bromocriptine

It can inhibit the secretion of prolactin and is suitable for anovulation accompanied by hyperprolactinemia. The dosage starts from 2.5 mg and is slowly increased and gradually decreased along with the PRL level. Generally, after 3-4 weeks of continuous use, the PRL can drop to normal and ovulation can be resumed.

7. Letrozole

It is an inhibitor of estradiol, which can inhibit the conversion of androgen to estrogen and reduce estrogen. It is usually taken orally starting on the 5th day of menstruation, 2.5-5 mg/day, for 5 consecutive days. Letrozole can be tried in patients with PCOS who are resistant to clomiphene.

8. Common side effects of ovulation-stimulating drugs

1. Adverse reactions such as lower abdominal pain, breast swelling and pain, nausea, dizziness, fatigue, rash, blurred vision, etc. may occur.

2. Multiple pregnancy: Increased ovulation significantly increases the chance of multiple pregnancy. Multiple pregnancy is a high-risk pregnancy, which will increase the miscarriage rate and premature birth rate of pregnant women, and is very likely to cause complications such as premature rupture of membranes, pregnancy-induced hypertension, anemia, and heavy bleeding during delivery.