Ovulation promotion process of Tulip International Reproductive Center in Kyrgyzstan: complete timeline and individualized management from drug use to egg retrieval

I. Definition: What is the ovulation induction process?

Ovulation-promoting process is a key link in assisted reproductive technology, which means stimulating the ovary by drugs to promote the synchronous development and maturity of multiple follicles, so as to obtain multiple eggs in one egg retrieval operation. The medical term for this procedure is "controlled ovarian stimulation". Medical research shows that the standardized ovulation induction process can improve the efficiency of a single treatment cycle and reduce the incidence of cycle cancellation. For cross-border medical people, understanding the process of promoting discharge is helpful to plan the trip, arrange accommodation and work vacation time.

Second, the applicable population to promote ovulation: Who needs a complete process?

The ovulation induction process is not suitable for all people. Common clinical adaptation groups include:

Infertility due to fallopian tube factor: In vitro fertilization (IVF) is needed to complete fertilization, and multiple eggs are needed to improve the cycle success rate.

Male infertility: need a sufficient number of eggs for intracytoplasmic sperm injection.

Ovarian reserve function is normal or slightly decreased: the response to ovarian stimulation can be predicted.

Those who plan to carry out embryonic genetic testing: need to form multiple blastocysts for biopsy and screening.

People who are not suitable for directly starting ovulation induction include: pregnant women, patients with hormone-dependent malignant tumors in breast or reproductive system, patients with unexplained abnormal uterine bleeding who have not been diagnosed clearly, and those who are allergic to the use of ovulation induction drugs in our center.

Expert tip:

The ovulation induction plan should be based on ovarian reserve assessment, age, body mass index (BMI) and previous treatment response. The stronger the regimen, the better the effect. Some patients are more suitable for microstimulation or natural cycle regimen.

Third, the technical basis: commonly used ovulation drugs and their mechanism of action

Ovulation-promoting drugs used by Tulip International Reproductive Center in Kyrgyzstan are mainly divided into the following categories:

1. Follicle stimulating hormone

Recombination FSH: such as Gonal-f and Puregon.

High purity urine source FSH: such as Menopur.

Function: directly stimulate the proliferation of follicular granulosa cells and promote follicular recruitment and development.

2. luteinizing hormone (LH) or HMG

Suitable for: patients with low gonadotropin, older people or people with poor response.

Function: Promote the production of androgen substrate, and assist the late maturation of follicles.

3. GnRH antagonists

Drugs: Cetrotide, Orgalutran.

Function: Inhibition of endogenous LH peak and prevention of premature ovulation of follicles.

4. GnRH agonists

Used for: long scheme or ultra-long scheme drop regulation

Function: Stimulate first and then inhibit pituitary function.

5. Trigger medicine

HCG (such as AZE, Profasi) or GnRH agonist (double trigger scheme)

Function: Simulate physiological LH peak and start the final maturation of oocytes.

The data show that a multicenter study published in Human Reproduction in 2023 pointed out that the average stimulation time of patients using GnRH antagonist regimen was 9 ~ 12 days, and the total FSH dosage was 1500～3000 IU. Different individuals have great differences.

Iv. detailed explanation of the process: the seven-step process of promoting the discharge of tulip international reproductive center in Kyrgyzstan

The following are the seven core links of the standardized emission promotion process of the center, which will be adjusted according to the monitoring data in actual implementation.

Step 1: Preparation before startup

Patients need to complete the following examinations (usually valid for 3 ~ 6 months):

Six basic hormones (2nd to 3rd day of menstruation)

Transvaginal ultrasound: basic follicle count, exclusion of ovarian cysts

Anti-Mullerian Hormone (AMH): Assessing Ovarian Reserve

Thyroid function, prolactin and vitamin D levels

Screening of infectious diseases (HIV, hepatitis B, hepatitis C, syphilis)

Step 2: Scheme Selection and Start Date

According to the evaluation results of ovarian reserve, the doctor chooses one of the following schemes:

Antagonist scheme: start FSH on the second to third day of menstruation, and add antagonists on the fifth to sixth day. Suitable for most patients.

Long-term plan: the agonist down-regulation was started in the middle of luteal phase in the previous cycle, and FSH was started two weeks later. It is suitable for people with polycystic ovary syndrome or high reaction.

Micro-stimulation scheme: low-dose FSH or clomiphene citrate combined with low-dose FSH is suitable for patients with significantly decreased ovarian reserve.

The first ovulation induction drug was injected on the start-up day, and the treatment cycle was officially started.

Step 3: Daily medication and self-management

Patients need subcutaneous injection of ovulation induction drugs at a fixed time every day. The center provides:

On-site nurse injection teaching

Video guidance material

Can return to the center for injection or be assisted by local nurses (for cross-border patients)

Precautions:

Repeated injections at the same site may lead to local induration, so it is suggested to rotate abdominal injection points.

Leaked drugs should be replenished within 2 hours, and doctors should be contacted if it exceeds 6 hours.

Step 4: Periodic follicular monitoring.

Monitoring frequency:

First monitoring on the 4th to 5th day after start-up.

Then every 1 ~ 3 days.

Monitoring every day or every other day after follicle diameter ≥ 14 mm.

Monitoring content:

Follicle diameter and number: measure the maximum diameter of follicles in bilateral ovaries.

Thickness and morphology of endometrium

Serum estradiol (E2), LH and progesterone (P)

Reference range of monitoring indicators:

Standard for mature follicles: 18 ~ 22mm.

The serum E2 corresponding to each follicle with a diameter of ≥14mm is about 200 ~ 300 pg/ml.

If LH≥10 mIU/mL appears in advance, it is necessary to strengthen the antagonist or trigger in advance.

Step 5: Timing and medicine of trigger

When one of the following conditions is met, arrange the trigger:

At least 3 follicles have a diameter of ≥ 18 mm.

The dominant follicle is 20-22mm and the subsequent follicle is ≥15mm.

E2 level reached the expected peak and there was no early LH peak.

Trigger drug selection:

Patient condition trigger scheme

Normal ovarian response was treated with HCG 250μg alone.

Polycystic ovary/high response double trigger (GnRH agonist+low dose HCG)

Embryogenetic test (PGT) GnRH agonist trigger

Arrange egg retrieval operation 34 ~ 36 hours after trigger. Too early or too late trigger will affect the egg capture rate and egg maturity.

Expert tip:

The trigger time determines the success rate of egg retrieval. A retrospective analysis covering 1845 cycles showed that the median acquisition rate of mature eggs was 82% when the dominant follicle reached 18-22 mm. If the trigger is triggered too early, the eggs may be immature, and if it is too late, the follicles will be over-aged or ovulate spontaneously.

Step 6: Final preparation before taking eggs.

Completed on the day of trigger day:

Sign the informed consent form for taking eggs.

Confirm anesthesia evaluation (intravenous anesthesia is used in the center)

Vaginal irrigation (prevention of intraoperative infection)

Fasting and water deprivation for 6-8 hours (under general anesthesia)

Step 7: Egg taking operation and subsequent treatment.

Egg retrieval process:

Ultrasound-guided transvaginal follicular puncture

Negative pressure suction follicular fluid

The laboratory staff immediately picked up the egg crown mound complex under the microscope.

The operation time is usually 10 ~ 20 minutes.

Post-treatment of eggs:

Eggs are placed in an incubator for fertilization.

Male sperm collection (frozen on the same day or in advance)

The number of eggs obtained may be inconsistent with the expectation, which is affected by follicular vacuole rate and egg maturity.

V. FAQ

Question 1: How long does it take to complete a discharge promotion process at the Tulip International Reproductive Center in Kyrgyzstan?

A: According to different schemes, most patients stay for 15-20 days from the second to third day of menstruation to one day after taking eggs. The antagonist program can complete egg retrieval in about 12 ~ 14 days. It is suggested to reserve 2 ~ 3 days to deal with individual differences.

Q 2: Can I travel or go on business during ovulation induction?

A: Long-distance travel during drug injection is not recommended. The reason is that the monitoring frequency is high (ultrasound and blood drawing every 1 ~ 3 days) and the injection time needs to be fixed. If necessary, you should consult with a doctor and bring a drug prescription and a cold chain package.

Q 3: Will ovulation be induced to overdraw the ovarian reserve in advance?

A: No. In each cycle, the ovary will collect a number of basal follicles. In natural state, only one follicle will mature, and the rest will be atresia and apoptosis. Ovulation-promoting drugs make these follicles that were supposed to be locked get development opportunities, and do not consume the follicle reserves in the subsequent cycle in advance.

Q 4: What are the most common side effects in the process of promoting excretion?

A: Common clinical side effects include redness or ecchymosis at the injection site, mild abdominal distension, transient mood swings and breast pain. The incidence of ovarian hyperstimulation syndrome (OHSS) is higher, but the incidence of moderate and severe OHSS is controlled between 2% and 6% under regular monitoring (data source: 2022 ASRM guide). The center reduces the risk by individualizing the starting dose and antagonist scheme.

Q 5: Can eggs be retrieved multiple times in one ovulation promotion?

A: One ovulation promotion process corresponds to one egg retrieval operation. If you need to take eggs again, you need to enter a new ovulation cycle, usually with an interval of 1 ~ 2 natural menstrual cycles, depending on the recovery of the ovary.

VI. Summary box

Summary: The core points of the discharge promotion process of Tulip International Reproductive Center in Kyrgyzstan.

Ovulation promotion is a key technical link to synchronize the development of multiple follicles in assisted reproduction.

The adaptive population needs to be determined after ovarian reserve assessment, which is not suitable for all people.

Commonly used drugs include FSH, LH, GnRH antagonists and trigger drugs.

The standard process includes: preparation before starting → scheme selection → daily medication → follicular monitoring → trigger decision → egg preparation → puncture egg collection.

The timing of trigger directly affects the quality of eggs, which needs to be comprehensively judged in combination with follicular diameter and hormone level.

The conventional residence time is 15 ~ 20 days, which fluctuates due to different schemes and individual reactions.

The center adopts intravenous anesthesia ultrasound-guided egg retrieval, and the operation time is 10 ~ 20 minutes.

Promoting ovulation will not overdraw ovarian reserve, and the incidence of moderate and severe OHSS is under control.

VII. Supplementary explanation: Practical suggestions for cross-border patients

For those who plan to go to Kyrgyzstan for assisted reproductive therapy, the following points will help to better cooperate with the process of promoting excretion:

Communication plan in advance: confirm the preliminary plan with the central doctor through online consultation or email, and some pre-start inspections can be completed in China.

Planning accommodation: choose accommodation close to the reproductive center to reduce the daily round-trip time. Extra time should be reserved during the rush hour in Bishkek.

Drug carrying: some drugs for promoting excretion need to be stored in cold chain, and confirm whether there is a refrigerator in the accommodation.

Language support: the center is equipped with a Chinese coordinator, and medical documents are provided in English/Russian/Chinese versions.

Emergency contact: Keep the center's 24-hour contact telephone number. If OHSS signs such as abdominal distension and dyspnea occur at night, you need to contact in time.

Each individual's reaction to promoting excretion is different, and the performance of the same scheme in different cycles may also be different. Medically, it is impossible to predict the exact number of eggs obtained in each ovulation promotion, and it is also impossible to make a success rate commitment. Following the doctor's advice and truthfully feeding back the physical feelings are the basis for obtaining ideal results.