Therapeutic target
Restoration of fertility (fertility)
Therapy recommendations
- Follicular stimulation (stimulation of oocyte maturation) and ovulation induction (ovulation triggering) for anovulation (failure to ovulate), oligomenorrhea (menstrual tempo disorder: interval between bleeding is > 35 days and ≤ 90 days), ovarian insufficiency (ovarian hypofunction):
- Clomiphene (antiestrogens) (see “Further notes” below.
- Gonadotropins – follicle stimulating hormone (FSH) recombinant; human menopausal gonadotropin (HMG); chorionic gonadotropin (HCG).
- Gonadotropin-releasing hormone analogs
- GnRH agonists
- “Long protocol * : Blockade of the pituitary gland (pituitary gland; downregulation) prior to gonadotrope administration in the context of in vitro fertilization (artificial insemination in a test tube).
- “Short protocol * * : after two-day application, combination with gonadotropins in the context of in vitro fertilization.
- GnRH antagonists – “antagonist protocol * * * : after administration of gonadotropins prevention of premature ovulation (ovulation) by applications of antagonists (“antagonists”) in the context of in vitro fertilization.
- GnRH agonists
- In cases of poor ovarian response (POR), i.e., women with a demonstrated poor ovarian stimulability (“low response”): DHEA supplementation (to be considered).
- Therapy of other underlying disorders are not presented here.
- See also under “Other therapy“.
Legend
- * “Long protocol” (classic): on the 21st – 23rd day of the cycle, a long-acting GnRH agonist is injected for downregulation. Stimulation with gonadotropins begins only after the onset of action.
- * * “Short protocol”: start on the 2nd day of the cycle with short-acting GnRH agonists (daily administration, nasal spray, injections). One or two days later, stimulation therapy begins simultaneously. Both are continued until HCG administration (ovulation induction).
- * * * “Antagonist protocol”: from the 2nd-4th day of the cycle, gonadotropins are injected for stimulation (FSH, HMG). From 6th/7th cycle day, GnRH antagonist (high single dose or low dose on several days) is injected to prevent premature ovulation. When the appropriate follicle size is achieved sonographically (by ultrasound) the final egg maturation is induced (triggered) via HCG, 34-36 hours later the follicle puncture (egg retrieval) is performed.
Further notes
- The results of a Dutch study of modified ovulation induction (M-OVIN) in women with normogonadotropic anovulation/absent ovulation with normal gonadotropin levels (i.e., hypothalamic-pituitary dysfunction) and clomiphene failure showed that extending drug-induced ovulation to 12 cycles of clomiphene instead of the maximum 6 cycles of clomiphene recommended by the NIC. Furthermore, it was shown that intrauterine insemination (IUI) did not significantly increase the rate of live births compared with “intercourse at the right time” (VZO).CONCLUSION: In women with normogonadotropic anovulation, assisted reproduction should only be performed after 12 cycles on clomiphene. In this case, intrauterine insemination is not required since “intercourse at the right time” is equally effective.
The following are terms that you will hear more frequently in connection with drug therapy:
Clomiphene | The full name is clomiphene citrate. Clomiphene is a drug in tablet form used for hormonal stimulation of the ovaries (ovary) |
Danazol | A synthetic hormone similar to yellow body hormone. A drug used primarily for the treatment of endometriosis. |
Dexamethasone | Dexamethasone is a cortisone preparation. It is used in very low doses to treat adrenogenital syndrome (AGS) from elevated androgens (male hormones). |
Downregulation | The word “downregulation” directly translated means “downregulation”. With a continuous administration of GnRH, the pituitary gland (hypophysis) is put out of function and the patient is thus put into “artificial menopause“. Downregulation is used during in vitro fertilization (IVF) |
FSH | FSH is a follicle-stimulating hormone (gonadotropin).It is a pituitary (hypophysis) hormone that can be injected as a drug to stimulate the ovaries (ovaries). |
GnRH | GnRH is the abbreviation for “gonadotropin releasing hormone”. Hormone of the hypothalamus that controls the release of LH and FSH in the pituitary gland. These in turn control the function of the ovaries, i.e. egg maturation (follicle maturation phase), ovulation and the corpus luteum phase. |
GnRH antagonists | GNRH antagonists cause the opposite of “gonadotropin releasing hormone” (GnRH) and are given to suppress ovulation. These cause a form of downregulation (see above). |
Gonadotropins | Gonadotropins (LH and FSH) – are hormones of the pituitary gland (hypophysis) that regulate the function of the ovaries (ovaries). They serve to mature eggs (follicles) and trigger ovulation (ovulation). |
HCG | HCG is the abbreviation for human chorionic gonadotropin. It is also called the pregnancy hormone because it is produced in high concentrations by the placenta (placenta) during pregnancy. It is administered intramuscularly as an injection during hormone therapy to induce ovulation (ovulation). |
Hyperstimulation syndrome (overstimulation syndrome). | A complication of hormone therapy. This results in severely enlarged ovaries (ovaries) with ascites (abdominal dropsy/pathological (abnormal) accumulation of fluid in the free abdominal cavity) and risk of thrombosis. |
LH | LH is the abbreviation for luteinizing hormone (gonadotropin). It is a hormone produced by the pituitary gland (pituitary gland) that causes ovulation (ovulation) in a mature follicle (egg sac). |
Estrogens (estrogens). | Estrogens belong to the group of female hormones. Although there are no “female” and “male” hormones, estrogens, unlike the “male” hormones, are produced in much higher concentrations in women, that is, they are present in higher serum levels. The best known estrogen is estradiol, which is produced exclusively by the granulosa cells in maturing follicles (ovarian follicles). |
Progesterone | Progesterone is also called the corpus luteum hormone. It is produced by the corpus-luteum (corpus luteum) in the second half of the cycle. It prepares the uterus for a possible pregnancy. If fertilization does not take place, the corpus luteum regresses. This causes the progesterone serum level to drop and the built-up uterine lining to detach, followed by menstruation. If pregnancy occurs, progesterone prepares the mammary glands for the production and release of milk. It also causes basal body temperature (BT) to rise during the second half of the cycle – permanently during pregnancy. Basal body temperature refers to the morning temperature, which is the temperature measured in the morning when you wake up. |
Prolactin | The hormone prolactin is produced in the anterior lobe of the pituitary gland. It has numerous functions, such as controlling milk let-down after birth. The release of prolactin is stimulated by the baby sucking on the nipple. Prolactin is also a stress hormone – prolactin serum levels increase under stress. Thyroid disorders – such as latent hypothyroidism (a clinically unremarkable form of hypothyroidism, often occurring together with galactorrhea, which means abnormal breast milk discharge) – can also lead to increased prolactin production. Elevated serum prolactin levels interfere with follicular maturation (egg maturation). |
Testosterone | Testosterone is the best known “male” hormone. It is produced in the testes, ovary (ovary), skin, and adrenal gland, and is called “male” because it is present in much lower concentrations in women than in men, that is, in much lower serum levels. It increases libido in women, but when in excess leads to general virilization (masculinization). |
Please note
The physical and mental health of both men and women, as well as a healthy lifestyle, are important prerequisites for successful fertility treatment.Before starting therapeutic measures, you should in any case – as far as possible – reduce your individual risk factors! Therefore, before starting any reproductive medical measure (e.g. IUI, IVF, etc.), have a health check and a nutritional analysis performed to optimize your personal fertility (fertility).
Supplements (dietary supplements; vital substances)
Suitable dietary supplements should contain the following vital substances:
- Vitamins (vitamin C (ascorbic acid), vitamin E (tocopherols), pyridoxine (vitamin B6), folic acid/5-MTHF, cobalamin (vitamin B12)).
- Minerals (magnesium)
- Trace elements (iron, iodine, selenium, zinc)
- Other vital substances (beta-carotene)
Note: The listed vital substances are not a substitute for drug therapy. Food supplements are intended to supplement the general diet in the particular life situation.