Types of Infertility Treatment Drugs Ovulation induction drugs are categorised as: SERMs: Clomiphene citrate Aromatase inhibitors: Letrozole Gonadotropins: FSH, LH preparations Adjunct therapies: Insulin sensitisers (e.g., metformin) Luteal phase support (progesterone) Step-by-Step Ovulation Induction Protocol Patient Selection Confirm anovulation Assess ovarian reserve (AMH, AFC) Exclude: Tubal pathology Severe male factor infertility Drug Selection PCOS Letrozole General anovulation Clomiphene/Letrozole Resistant cases Gonadotropins Monitoring Follicular tracking starting Day 910 Dominant follicle: 1820 mm Endometrial thickness: 7 mm Trigger & Timing Administration of hCG trigger (mimics LH surge) Ovulation occurs ~36 hours post-trigger Timed intercourse or intrauterine insemination is planned accordingly Risks and Complications Ovarian Hyperstimulation Syndrome (OHSS) More common with gonadotropins Pathophysiology: Increased vascular permeability due to VEGF Features: Ascites, enlarged ovaries, hemoconcentration Multiple Pregnancy Clomiphene: Increased twin rate Gonadotropins: Higher risk of multifetal gestation Other Adverse Effects Functional ovarian cysts Vasomotor symptoms (clomiphene) Abdominal discomfort Ovulation Induction in PCOS Patients Key pathophysiology: Increased LH: FSH ratio Hyperandrogenism Arrested follicular development Management principles: Letrozole as a first-line agent Lifestyle modification (weight reduction improves ovulation) Metformin in insulin-resistant individuals Clomiphene resistance is defined as failure to ovulate at the maximum dosage
For microdosing, they do not select the full dosage and stop rotating the wheel at lower doses
Plain rice with chicken works well
Measurement of plasma concentration profiles after nutrient ingestion (e.g
Namely this subset includes measurements at partial load, rated power and full-load
However, he highlights research showing that individuals with obesity have a blunted GLP-1 response to carbohydrates, which may contribute to overeating
