"Du Miaomiao" and "Huluwa" - Ovulation-inducing technology in IVF

One of the biggest advances in modern IVF technology is the birth of "ovulation induction" technology. Since the advent of this technology, women could only obtain one dominant follicle and release one egg in a month. Now, it is possible to obtain multiple dominant follicles at a time in a month, obtain multiple eggs, and pair them with sperm in vitro, which greatly improves reproductive efficiency and turns "single seedling" into "calabash brothers"!

What is “ovulation induction” technology?

In a broad sense, it includes ovulation induction and controlled super ovulation. Ovulation induction refers to the use of drugs to induce ovulation in patients with ovulation disorders. It is generally aimed at inducing the development of a single follicle or a few follicles. It is suitable for women with anovulation, such as patients with polycystic ovary syndrome. Commonly used drugs include clomiphene, aromatase inhibitors, and gonadotropin drugs. Ovulation induction after entering the test tube cycle refers to controlled super ovulation.

It mainly refers to the use of drugs to induce the development and maturation of multiple follicles within a controllable range. The commonly used drugs are gonadotropin-releasing hormone analogs. This is what we test tube sisters usually call "ovulation-stimulating injections"!

How to give the “ovulation-stimulating injection”?

The plan formulated according to different dosage, time, method, etc. is the clinical ovulation induction plan. It mainly includes the following types:

(1) Long plan : Starting from 7-10 days before menstruation, GnRH agonists are used to downregulate the pituitary gland. Gonadotropin (Gn) is added on the 2nd or 3rd day of menstruation to promote ovulation until HCG injection is stopped. Pituitary downregulation helps doctors to more effectively control the ovulation process and allows multiple follicles in the ovaries to develop and mature synchronously. This plan is generally suitable for patients with good ovarian reserve function, has good treatment effects, and is widely used in clinical practice.

(2) Super long plan : inject a long-acting GnRH agonist every month before the ovulation induction cycle for 2-3 months, and then start using Gn to induce ovulation. It is generally suitable for patients with endometriosis and adenomyosis, and is also often used for patients with repeated transplantation failures. It takes a relatively long time and is more expensive.

(3) Short regimen: GnRH agonist is injected on the 2nd or 3rd day of the menstrual cycle, and Gn is given to promote ovulation at the same time until HCG is injected. This regimen is shorter than the long regimen, but the synchronization of follicle development and endometrium during the cycle is slightly worse. For patients with poor ovarian reserve function, short regimen treatment can achieve relatively ideal results.

(4) Antagonist regimen: No down-regulation is required. Gn is started on the 2nd or 3rd day of the menstrual cycle, and GnRH antagonists are started on the 5th to 6th day of medication or when the dominant follicle reaches a diameter of 12 mm. This regimen is relatively simple to use, relatively inexpensive, and effective. It is suitable for all types of people and has gradually become the mainstream of ovulation induction regimens in recent years.

(5) Minimal stimulation regimen: The minimal stimulation regimen is to first give clomiphene or letrozole orally, and then give a small dose of Gn. A GnRH antagonist may be added during the process. This regimen is the first choice for patients with ovarian dysfunction. It can also be used in people with ovarian hyperresponsiveness to reduce the occurrence of ovarian hyperstimulation (OHSS).

(6) Others: luteal phase regimen (using progesterone to induce ovulation), natural regimen and modified natural regimen, etc.