In the journey of in vitro fertilization (IVF), "ovulation induction" is a crucial step. Many expectant parents feel unfamiliar and confused about ovulation inducing drugs. In order to help everyone better understand, the expert team of Tulip International Reproductive Center will provide a detailed explanation of the effects and usage of various ovulation inducing drugs through Q&A, unveiling their mysterious veil for you.

Q1: What is "ovulation induction"? Why is this step necessary for IVF treatment?

A: Ovulation induction, medically speaking, refers to the use of medication intervention to break the natural laws of single follicle development and promote the synchronous growth and maturation of a group of antral follicles in the ovary.

In a woman's natural menstrual cycle, typically only one follicle can mature and be expelled each month, which is sufficient for natural conception. But in IVF treatment, in order to improve the success rate, we need to obtain multiple mature and high-quality eggs at once. Because there is a possibility of loss at every stage from egg retrieval, in vitro fertilization to embryo culture. Obtaining more eggs means having more opportunities to form high-quality embryos that can be transplanted, thereby increasing the chances of successful pregnancy. Therefore, at Tulip International Reproductive Center, doctors will develop personalized ovulation induction plans for you to activate your ovaries and obtain the desired number of mature eggs.

Q2: What are the main drugs that promote follicle growth? What is the difference between them?

A: The core hormone that promotes follicle growth is follicle stimulating hormone (FSH), sometimes requiring the synergistic effect of luteinizing hormone (LH). In clinical practice, these types of drugs are mainly divided into the following categories:

1. Recombinant FSH drugs:

Gonal-f: The main component is recombinant human follicle stimulating hormone (rFSH), which is used to stimulate the growth and development of follicles and is a commonly used drug in various ovulation induction regimens. It usually adopts the form of an "injection pen", with precise dosage adjustment. Users can inject subcutaneously on their own, with easy operation and mild pain.

Puregon/Follistim: Similar to gonadotropin, it is also a high-purity rFSH that helps multiple follicles develop by stimulating the ovaries. The injection method is also a convenient injection pen.

Rekovelle: This is a novel rFSH drug characterized by a highly individualized calculation of the initial dose, which is precisely formulated based on the woman's anti Mullerian hormone (AMH) levels and weight, aiming to achieve better ovarian response.

Bemvola: It is also an rFSH drug, characterized by a fixed dose, disposable pre filled injection pen, which is very convenient to use.

This type of drug is produced through genetic recombination technology, with high purity, good stability between batches, and extremely low risk of allergic reactions.

Representative drugs:

2. Urinary derived FSH/HMG drugs:

Fostimon: Provides exogenous high-purity urine derived FSH for stimulating the growth and development of multiple follicles in the ovary.

Menopur: This is a human menopausal gonadotropin (HMG) containing two active ingredients, FSH and LH. It can simulate the synergistic effect of FSH and LH, jointly promoting follicular development, often referred to as the "golden partner".

This type of medication is extracted and purified from the urine of postmenopausal women, and is a long-standing ovulation inducing drug.

Representative drugs:

3. FSH and LH combination therapy:

Pergoveris: This is a combination of recombinant FSH and LH. It is also a "golden partner" that promotes follicle growth by simulating the synergistic effect of FSH and LH during follicular development, especially suitable for patients with low LH levels in the body.

Q3: During ovulation induction, how to ensure that the egg does not "run away prematurely" before egg retrieval?

A: 'Running away early' in medicine refers to 'premature ovulation'. When follicles develop to a certain size, there may be a spontaneous surge of luteinizing hormone (LH) in the body, which triggers ovulation. If it happens before the egg retrieval surgery, we will lose these precious eggs. To avoid this situation, doctors will use ovulation control drugs, which are mainly divided into two categories:

GnRH Agonist:

Mechanism of action: This type of drug briefly stimulates the pituitary gland during initial use, but after continuous use, it becomes strongly inhibitory, making the pituitary gland no longer sensitive to endogenous GnRH signals, thereby achieving a deep inhibition of endogenous LH peaks and preventing premature ovulation.

Representative drug: Decapeptyl.

GnRH antagonist:

Mechanism of action: This type of drug acts as an "interceptor" that can directly and rapidly bind to the GnRH receptor in the pituitary gland, but does not produce excitatory effects, thus quickly blocking the ovulation instructions issued by the brain and effectively inhibiting LH secretion. It works very quickly and is usually used only after the follicles have grown to a certain size.

Representative drugs: Cetrotide and Ganirelix.

At Tulip International Reproductive Center, our doctors will select the most suitable controller medication for you based on your specific situation and the chosen ovulation induction plan, ensuring that each follicle can be removed at the most ideal time.

Q4: What is a 'night needle'? Why play at night?

A: The 'night needle' is the last and most crucial injection in the ovulation induction process. Its main components are usually human chorionic gonadotropin (hCG) or GnRH agonist (GnRH-a).

Its core function is to simulate the LH ovulation peak in the natural cycle of women. This powerful hormone signal is the "master switch" that initiates the ultimate maturation of the nucleus and cytoplasm of the egg. Only upon receiving this instruction will the egg complete meiosis, transition from "juvenile" to "adult", and ultimately possess the ability to fertilize.

The reason why it is usually injected at night is that it takes about 34-36 hours from injection until the egg is fully mature and suitable for retrieval. The doctor will accurately calculate the time and schedule the injection at night, so that the egg retrieval surgery can be arranged during the day 36 hours later. Therefore, the injection time of "night needle" must strictly follow the doctor's advice, accurate to the minute.

Representative drugs: Ovidrel (recombinant hCG), hCG (urinary derived hCG).

Q5: Case Study: What is a complete ovulation induction process at Tulip International Reproductive Center?

A: Ms. Zhang, 35 years old, chose to undergo in vitro fertilization treatment at the Tulip International Reproductive Center due to bilateral fallopian tube blockage. Her AMH value is 1.5ng/mL, indicating a state of adequate ovarian reserve.

Plan development: The center's expert team developed an antagonist plan for Ms. Zhang based on her age, AMH value, weight, and basal follicle count. Gonal-f was chosen as the ovulation inducing drug, with an initial dose of 175 IU/day.

Initiation and Monitoring: On the third day of her menstrual cycle, Ms. Zhang started subcutaneous injections of Gonafen every day. From the 5th day of injection, she regularly returned to the center for B-ultrasound monitoring of follicle size and blood tests for hormone levels (such as E2, LH, P, etc.). Based on the monitoring results, doctors fine tune the dosage of gonadotropin to ensure even growth of follicles.

Prevention of premature ejaculation: When the maximum follicle diameter reached 14mm, the doctor added GnRH antagonist Ganirelix injection to Ms. Zhang once a day to prevent premature ejaculation of follicles.

Determine the timing of the night needle: After 10 days of stimulation, B-ultrasound showed that Ms. Zhang had 4 follicles with a diameter exceeding 18mm and 6 follicles with a diameter exceeding 16mm, with ideal levels of estradiol (E2). After comprehensive evaluation, the doctor determined the "night shot" time and scheduled to inject Ovidrel on time at 9:30 pm that evening.

Successful egg retrieval: 36 hours after the night injection, at 9:30 am on the third day, Ms. Zhang underwent painless egg retrieval surgery at the Tulip International Reproductive Center and successfully obtained 11 mature eggs.

Through this personalized and closely monitored ovulation induction process, Ms. Zhang has laid a solid foundation for subsequent embryo culture and transplantation.

For fertility consultation in Kyrgyzstan, please contact your dedicated consultant

/Fertility Consultation /

Dr.Chan

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