The path to parenthood is a complex journey, filled with many steps and decisions. One crucial stage in this journey is ovulation. It's important to understand how ovulation is triggered, especially for couples undergoing fertility treatments.
At MOM IVF, we are dedicated to providing personalized, caring fertility treatments, making the dream of parenthood a reality for everyone.
In this blog, we'll explore the detailed process of ovulation and the methods used to trigger it.
Starting a family is a big dream for many couples. But did you know that getting pregnant involves many steps, and one of the most important is ovulation? Ovulation is when an egg is released from the ovary, and it's crucial for making a baby.
Understanding how ovulation happens is really important, especially for couples who are trying to have a baby with a little bit of help.
We're here to help couples who are struggling to conceive. We provide personalized and caring fertility treatments to make the dream of having a baby come true for everyone.
Understanding Ovulation
The normal menstrual cycle is a complex process that involves different parts of the body such as the brain, ovaries, and uterus. One important stage of this cycle is called ovulation, which is when an egg is released from the ovary. Let's break down the process:
- Follicular Phase:
At the beginning of the menstrual cycle, the brain sends a signal to the ovaries to start preparing an egg for ovulation. This signal causes a hormone called follicle-stimulating hormone (FSH) to rise. As a result, the ovary starts producing another hormone called estrogen (E), along with luteinizing hormone (LH).
- Growth of the Follicle:
As the menstrual cycle progresses, one of the follicles in the ovary starts to grow and develop. This follicle is called the dominant follicle. As it grows, the levels of estrogen (E) increase. The increase in estrogen causes a decrease in FSH, and this negative feedback helps the dominant follicle to emerge. The dominant follicle is the one with the highest number of receptors for FSH and LH, as well as the highest levels of estrogen (E2).
Understanding this process is important because it helps us to know when ovulation will occur. In the next stage, the surge of LH hormone, triggered by the high levels of estrogen, will cause ovulation, the release of the egg from the ovary. This is the first step towards pregnancy.
Mechanism of Ovulation Triggering
Ovulation is the process where an egg is released from the ovary. This process is mainly triggered by a hormone called LH. For ovulation to happen, there needs to be a specific level of another hormone called estrogen (E) for about 50 hours.
Just having enough hormones doesn't always mean ovulation will occur. The follicle, which is a small sac in the ovary, must be mature enough to respond to the signal that tells it to release the egg.
A normal LH surge, or increase, lasts for about 48-50 hours and has three phases: an initial phase of speeding up, a middle phase where the levels stay the same, and a final phase where it slows down. The LH surge does a few important things:
- It tells the egg to start dividing again (this is called the resumption of meiosis).
- It helps the follicle burst, releasing the egg.
- It creates something called the corpus luteum.
When the ovaries need a little help, as in controlled ovarian stimulation, the follicle is encouraged to develop with the help of hormones. Ovulation is then triggered using a hormone called human chorionic gonadotropin (hCG), acting as a substitute for LH.
Unlike the natural LH surge, which only lasts for 48-50 hours, the hCG surge lasts several days. This leads to higher levels of Estradiol and Progesterone, as well as vasoactive amines. To avoid a potential problem called Ovarian Hyperstimulation Syndrome (OHSS), triggering with a GnRH agonist-antagonist cycle is recommended.
GnRH Agonist Triggering
When we use GnRH agonist to trigger ovulation, it works by causing a surge of two important hormones called LH and FSH, which are needed for ovulation. However, the surge caused by GnRH agonist is short, lasting only 24-36 hours, and it has only two phases instead of three like the LH surge.
Because of this short surge, the corpus luteum, which is necessary for maintaining pregnancy, is not as strong, leading to a deficient luteal phase. As a result, pregnancy rates are significantly lower.
To fix this problem, we use a strategy called the dual trigger. This means we combine the GnRH agonist with hCG. By doing this, we get the benefits of both triggers. The GnRH agonist causes the LH and FSH surge needed for ovulation, and the hCG helps in supporting the luteal phase.
This combination helps in correcting the luteal phase defect, resulting in better pregnancy rates. So, by using both triggers together, we can increase the chances of a successful pregnancy for our patients.
Ovarian Hyperstimulation Syndrome (OHSS)
OHSS is a complication caused by fertility treatments, with moderate cases affecting about 5% of patients. Thanks to the increasing use of antagonist protocols, OHSS rates have dropped significantly. To avoid OHSS, especially for high responders and patients with a history of OHSS, doctors recommend using GnRH agonist triggering instead of hCG.
Segment-A: Optimization of ovarian stimulation, including GnRH agonist triggering in a GnRH antagonist cycle.
In this segment, we focus on making the treatment safer. By using a special method called GnRH agonist triggering during the treatment, we can help prevent OHSS. We carefully monitor the stimulation of the ovaries to make sure it's just right for the patient.
Segment-B: Optimum cryopreservation methods for oocyte or embryo vitrification.
This part is about preserving eggs or embryos in the safest way possible. By freezing them using a special method called vitrification, we can keep them safe until they're needed. It's like putting them on hold until the time is right.
Segment-C: Indications for the use of Agonist Trigger.
This segment tells us when to use GnRH agonist triggering. We use it for patients who might be at risk of OHSS. By doing this, we can make sure the treatment is safer for them.
In short, the OHSS-free clinic is a place where we use special methods to make sure patients undergoing fertility treatment don't develop OHSS.
We do this by carefully controlling how we stimulate the ovaries, freezing eggs and embryos safely, and using special triggers when needed.
Types of GnRH Agonist Trigger
Decapeptidyl: Decapeptidyl is a type of GnRH agonist trigger used to induce ovulation. It is administered in doses of 0.2 mg subcutaneously. At MOM IVF, we use decapeptidyl for patients with specific conditions.
It is given to patients who have more than 20 follicles seen on ultrasound, patients with E2 levels greater than 4000 pg/ml, and patients with oocytes having follicles more than 15 on ultrasound.
Leuprolide acetate: Leuprolide acetate is another type of GnRH agonist trigger used for ovulation induction. It is administered in doses of 4 mg subcutaneously. At MOM IVF, we primarily use decapeptidyl for ovulation triggering due to its effectiveness and the specific conditions it's ideal for.
We choose decapeptidyl 0.2 mg subcutaneously trigger for patients who meet any of the following criteria:
- Patients with more than 20 follicles seen on ultrasound.
- Patients with E2 levels greater than 4000 pg/ml.
- Patients with oocytes having follicles more than 15 on ultrasound.
By tailoring the choice of trigger to the individual patient's condition, we aim to ensure the most effective and safest treatment possible.
Ovulation Induction in Hypogonadotropic Hypogonadism (HH)
Hypogonadotropic hypogonadism (HH) is a rare problem in the reproductive system where the issue is in the hypothalamic-pituitary axis. This problem is called type 1 amenorrhea by the WHO. What this means is that women with this condition don't get their periods.
To help women with HH get pregnant, a method called ovulation induction (OI) is used. The main way to do this is through gonadotropin therapy. Gonadotropins are hormones that help in the development and release of eggs from the ovaries.
How Ovulation Induction Works:
- Diagnosis: When a woman is suspected to have HH, she will be checked according to a usual process. Doctors will check if there are any structural problems in the reproductive tract, check the husband's semen analysis, and ensure that the fallopian tubes are open.
- Treatment: The main treatment is gonadotropin therapy. It can be done by giving urinary preparations (hMG) or recombinant FSH along with recombinant LH or low dose hCG. Oral agents or only FSH injections are not helpful.
- OI Protocols: The process usually starts with 150 IU of hMG given daily for 5 days. Then, the patient's condition is checked. On day 6, a transvaginal scan (TVS) is done to see if there is any follicular growth and the E levels are checked. Once these criteria are met, ovulation is triggered with hCG 10,000 IU.
- Optimal LH Dose: Various studies have been done to find the best dose of LH for ovulation induction in HH. Patients with LH less than 1.2 IU/ml are the ones who will benefit most from supplementing LH.
Newer Developments and Adjuvant Therapies
Researchers are exploring various additional treatments to enhance pregnancy rates in patients with hypogonadotropic hypogonadism (HH). These include growth hormone (GH) and pretreatment. Another promising development is the use of a long-acting FSH hormone called Corifollitropin alfa.
It may help reduce the frequency of injections to just once a week while maintaining similar effectiveness as conventional gonadotropins. Additionally, Kispeptin, a hormone that stimulates the HPG axis, has shown potential. Kispeptin can increase the natural release of FSH and LH, further aiding in the ovulation process.
These advancements offer hope for individuals facing difficulties with ovulation. By exploring and adopting these treatments, doctors can improve the chances of successful pregnancy for patients with HH. As we continue to study these new approaches, we are moving closer to providing effective solutions for infertility, ensuring that more people can realize their dreams of becoming parents.
Conclusion:
Understanding the triggering of ovulation is essential for successful fertility treatments. At MOM IVF, we are dedicated to providing high-quality, effective, and transparent treatment to all our patients.
By implementing advanced techniques and staying abreast of the latest developments in the field, we aim to ensure that every patient has the opportunity to embrace the joys of parenthood.