Ovulation Induction: An Unusual Ultrasound Example
An unconventional example of ovulation induction ⤵️ from our obstetrician-gynecologist and reproductive specialist, Anfisa Anatolyevna Gashchenko #vitaliseco_patientstories:
"Today I want to tell you about how ovulation induction can proceed, and it doesn't always go according to plan.
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I was inspired to write this post by an initial consultation with a young 26-year-old patient who had already undergone an ovulation induction cycle with another gynecologist. She was extremely upset because the gynecologist hadn't seen the results of the stimulation and suggested that IVF might be necessary 🧪.
The patient hadn't ovulated regularly and was diagnosed with PCOS. She hadn't had any spontaneous periods, so the start of a new cycle had to be induced by taking Duphaston and then discontinuing it 💊.
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To my question, "Why IVF? There's no indication for it, and you're a clear candidate for ovulation induction," the patient replied that she'd already undergone induction three times with Clomiphene 2 over five days in the first half of her cycle, and all three times were unsuccessful. The gynecologist said "the ovaries didn't respond." 😏🤔
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So today I want to give a clear example of how, in some cases, the standard five days of Clomiphene 2 are not enough for the dominant follicle to grow to the size necessary for ovulation. Don't jump to conclusions and say "there's no ovarian response to stimulation." You just need to see the process through to its logical conclusion. 👌.
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So, here's an example in the video 🎥. Here we see an ultrasound of one of my patients on day 10 of her menstrual cycle. From days 5 to 9, clostilbegyt was prescribed at a dose of 100 mg/day. A follow-up ultrasound shows a very thin endometrium (3 mm) and dominant follicles in the ovaries: one on the left, 10 mm in diameter, and two on the right, 9 and 10 mm. The remaining follicles are small, 3-7 mm in diameter, and clearly no longer compete for ovulation.
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Stopping induction at this stage and concluding that the ovaries have not responded would be the wrong decision ✋, so we go ahead and prescribe low-dose gonadotropins 🤏. These same medications are also used in IVF protocols, but higher doses are used there to obtain a large number of eggs. Here, we don't need much; we stimulate the growth of a small number of follicles. Literally 1-2, rarely 3. This is sufficient for both IUI and natural fertility planning. 🍀
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Furthermore, given the relatively thin endometrium, we will also adjust this aspect: in addition to gonadotropins, I will add small doses of estrogen; they will counteract the negative impact of clostilbegyt on endometrial proliferation. Well, I'll tell you later what the outcome will be when I have the results. 😉