| Lt. Col. Dr. Theerapong free. The next question may be that "all women are" eggs "fall in a single month or not."
The truth is that human nature is a complex process of creating eggs. In the period before menstruation. It is the growth of cells "egg" and "egg" in the term that originally grow yourself a lot with what the mechanism is unknown. The take about 10 weeks, it will be early-stage oocyte activation, which barely meet the women are just a month. Typically, the first stage of the reproductive cells, eggs, thousands of leaves. Has grown from time. But each side does not exceed 20 tickets remaining at the beginning of a new menstrual cycle.
The growth of "eggs" at the beginning of the menstrual cycle need to be received stimulation. "Command or signal from the brain, only it will grow further. Commands or signals from the brain. (Gonadotropin) generated from the pituitary gland part (Anterior pituitary), so it is a hormone from the pituitary gland Front (Pituitary Hormone) and one type is controlled by hormones from the brain Hypothalamus again.
Hormones from the brain Hypothalamus (Neurohormone) that controls a signal from the brain only has only one type of Gonadotropin Releasing Hormone, which is called simply called GnRH (N He.. R. H).
"Eggs" that grow from the start of the menstrual cycle to hormone s estrogen. The greater the size and amount of "Eggs" A hormone estrogen will stimulate the growth endometrial thickening, respectively.
In general, S estrogen or S estrogen with progestogens PC Rhone with a high level will be inhibited secretion of Gonadotropin (Negative Feedback), but in the medium-term menstrual cycle at S estrogen. The more than 200 pg / ml or more percent. This coupled with the concentration remains at this level for more than 50 hours, instead of sending the press secretion of LH becomes an induced stimulus to secrete substances LH volume (Positive Feedback) the condition referred to as "LH SURGE" which the key processes that result in "egg" fall in approximately 24-36 hours.
Where the "eggs" fall in the ovary becomes a section called "Corpus Luteum" serves to create and secrete sex hormones estrogen and S progestogens PC Rhone out.
Hormones, progestogens PC Rhone-acting press secretion of GnRH (Negative Feedback) At the same time will result in endometrial changes in conditions appropriate to the embedding of the "soft".
BASIS OF encourage ovulation.
The most important thing is the ovary. There is also still working on "egg" and a sex hormone. Women deserve to induce egg activation and are falling.
1. Women who have abnormal hormone Like
1.1 abnormal levels of the brain to send the Hypothalamus, which is often associated with stress. Weight much or too little.
1.2 abnormal level of command. The pituitary gland, such as a tumor of the pituitary gland.
2. Women who have disorders of ovulation in the "egg" does not fall.
Eggs and egg activation induced by fall with three different ways.
Approach to activation of a command system in the brain.
The second approach directly stimulate the ovaries.
3 ways to use both approaches together.
A way that stimulates the brain ordering system. Ie.
Activation of the pituitary gland of the page and / or Hypothalamus.
Drugs are drugs that act motivated Clomiphene citrate, hormones from the Hypothalamus (GnRH) and Bromocriptine.
CLOMIPHENE CITRATE. Type A hormone is a substance against a type of estrogen action by taking to the hormone estrogen in A capture point where S estrogen action, such as location Hypothalamus pituitary ovary and uterus.
For the position Hypothalamus and pituitary gland will result in the secretion of GnRH and Gonadotropin stimulation causes more eggs and more eggs growing up, most of the former. Do not scare away almost all the natural mechanism. Only eggs that grow to be the right size leaves many eggs they have good properties in fertilization as well.
An indication of Clomiphene Citrate.
1. Women have children is difficult due to neutropenic fever did not fall. Especially those resulting from the brain system is not performing well as they should, and diseases of the ovary.
2. Women did not fall evenly with egg and / or employment status of the Corpus Luteum Deficiency.
3. To determine the duration of the infection screening & injection into the uterus.
4. The egg activation process in vitro child.
How to use the drug.
The medication began on day 2 and 5 of the menstrual cycle. Then track the growth of "eggs" with a view ultrasound through the vagina. Or in combination with the hormone in blood See the egg create When the eggs grow to the proper size. Eggs might fall off their own mechanism of natural or controlled by the drug to induce the egg to fall by the time we need time.
Restrictions on the use of Clomiphene Citrate.
1. Pregnant women.
2. Ketoacidosis, cirrhosis of the liver damage.
3. Abnormal bleeding from the uterus.
The success of treatment.
Ovulation rate was 80 percent and a pregnancy about 40 percent of this amount was 5 percent of pregnant twin pregnancy, most often occurs within 3-5 months.
Disadvantages and complications.
Clomiphene is due to anti-estrogen hormone A has a negative effect on the cervix. In response to the estrogen hormone, S. Resulted in the cervix thick mucus. An obstacle in passing to the sperm also may adversely affect the lining of the uterus with
For complications that may experience symptoms include hot flushes, abdominal pain, flatulence sore breast screening. Blurred vision, headache, nausea, vomiting, hair loss, ovarian growth may be more to the neonatal ovary is stimulated by too much.
BROMOCRIPTINE.
Bromocriptine. The inhibition of pituitary secretion of Prolactin inhibits the front in normal Bromocriptine. Prolactin action can reduce the level in normal Bromocriptine. Prolactin levels can reduce the action within 1 hour after medication. And inhibit secretion of up to 12 hours.
Help.
Generally started in low dose before the drug to reduce side effects of drugs. Most of the once daily in the evening or before bedtime with food. When can tolerate the drug well, it gradually Adjust the size of the drug as appropriate by way of the drug for 2 ways.
May contact the drug every day until pregnancy or the early stages of the drug only to the level at which the eggs and then fall off and new drugs in the next menstrual cycle when not pregnant.
It also may be used in conjunction with Clomiphene Citrate in stimulating egg treated with
Women with children in difficult circumstances indicate that the drug therapy. Bromocriptine was found that when used in combination can induce the egg to fall pregnant and 80 percent by this drug does not seem to affect the child's disability in any way.
Complications. The most common include nausea, vomiting, fainting when sitting or standing up quickly. Head numbness, headache, diarrhea.
GnRH (Gonadotropin Releasing Hormone).
GnRH is a hormone that creates the Hypothalamus action at the pituitary gland to create a front and back. Gonadontropin (FSH & LH) to stimulate the ovaries to produce "eggs" again. So for women who need treatment with a GnRH pituitary and ovarian function normal to be able to respond to GnRH.
When the GnRH consecutive long. The activation of the pituitary gland only during only the first. Then it changes to a depression of the pituitary gland. Gonadotropin due to a higher level in the first phase gradually decreased, respectively.
Treatment with a GnRH pulses work better in women with abnormal secretion of GnRH Hypothalamus in which the majority will come with a doctor about lack of menstruation
It is also used to treat various conditions as follows.
1. Prolactin levels in women with high blood over
2. Some patients do not respond to medication Clomiphene Citrate.
3. Folocles stimulate the growth of children in the process tube.
4. Conditions that have impaired function of the Corpus Luteum.
How to use drugs to stimulate GnRH induction of egg and egg drop Do this is to mimic natural GnRH every 60-120 minutes using automatic injection. Injection under the skin or vein to this, throughout pregnancy or until the eggs until the fall and holiday time. Most popular drug in 5 of the menstrual cycle.
Of pregnancy
| Outcomes as has been reported from 1984 to 1980, with 36 reports. |
Number of women.
Number of treatment cycles.
Of pregnancy
Number of twin pregnancy.
Abortion.
Ovarian stimulation condition was too much. | 388
916
216
16
31
10 | (56 percent).
(7.3 percent).
(14 percent).
(1.1 percent). |
For baby's disability as not to pass on this report.
Complications were few and mild, such as inflammation of the blood vessel or a blood clot at the injection lock.
Currently, the use of GnRH to stimulate the egg drop is not much because it requires injections and continued to have any real indication, however, that the GnRH is a lot to look forward to the press. Work order system in the brain of the Hypothalamus in conjunction with ovarian stimulation, drug Gonadotropin (FSH & LH) for a gift or child vitro.
The second approach directly stimulate egg.
Gonadotropin (FSH & LH).
Synthetic Gonadotropin production from isolated from urine of postmenopausal women with high FSH and LH levels, but the current power plant using urine from menopausal women. Find more difficult to find anywhere, so a new power plant. The larger is. They are not limited to microorganisms (Recombinant DNA).
An indication of GONADOTROPIN.
- Women with no ovulation.
- Egg activation in vitro child process and technology, other high fertility.
- Women with uterine mucus, the poor
- Women with impaired function of the Corpus Luteum.
Of HMG to stimulate eggs to make the "eggs" lots and quantity S estrogen doses that high as possible Induced LH Surge up naturally, which may adversely rather than a benefit. Thus, together with the GnRH Agonist to inhibit secretion of Gonadotropin (FSH & LH) from the brain will not help to have the LH Surge in naturally. Is very useful in controlling the "egg" that grow all used to the proper fertilization.
Complications. Are important. Twin pregnancy and conditions that stimulate the ovaries were too much for twin pregnancy was 25 percent with 5 percent are triplets or more pregnant.
Outcomes.
Ovulation rate by using this method as high as 90 percent, but it depends on the women themselves. Treatment and follow up treatment.
Of pregnancy
Pregnancy rate varies between 23-82 percent of women depending on pathological features and frequency of treatment away.
PURE FSH. There is an indication.
1. If the women have Polycystic Ovarian Disease status because these women are already high levels of LH.
For ovulation rate and pregnancy from the use of Pure FSH was not significantly different from the use of HMG / HCG.
2. Used in women with impaired function of the Corpus Luteum due Follicle growth may be caused by abnormal levels of FSH during the first menstrual cycle. Lower than it should be.
The cumulative pregnancy rate at 6 months treatment was 48 percent.
3. Use the Activation of eggs in vitro process that child. Results did not differ from the use of (Clomiphene Citrate) / with HMG.
3 ways to stimulate the control command. With ovarian stimulation directly
Such as the use of Clomiphene Citrate with HMG Pure FSH etc.
Activation of eggs is not difficult or anything weird. True, but to make what we've already had the body. Oocytes is that many grow their own. Not be neglected by useless Back can also be used with good results. This can be seen from the second born twins or triplets or more from the treatment. And make people misunderstand that the egg is stimulated to "twin children."
Activation of eggs and induced to fall even though it is not difficult, but it should be in the hands of medical professionals in this particular Otherwise, if complications come up, it may adversely affect physical and hard-to-fix remedies.
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