Conservative treatment
Conservative treatment is intended to evoke ovulation by application of ovulation-inducing medicines.
Conservative treatment is intended to evoke ovulation by application of ovulation-inducing medicines.
What is conservative treatment?
What is conservative treatment?
One of the reasons for female infertility may be ovulation disorder or an anovulation (the latter proves to by the cause for infertility for some 15-25% of couples).
In such a case, a standard symptom is irregular menstruation or even absence of a menstrual period altogether. The objective of the treatment is to evoke ovulation by application of ovulation-inducing medicines.
Diagnostics
Required testing
Female partner
Female partner
Male partner
Male partner
For treatment to be effective, the most common other causes of infertility must be ruled out by running the above tests.
Treatment
Course of treatment
Stage I
History and analysis of infertility
During the first appointment with the doctor a history is taken, including details of the regularity and duration of the menstrual cycle. During a TV ultrasound, which should be an integral component of the gynaecological examination, the structure of the uterus and ovaries is checked. This already allows for preliminary conclusions regarding ovulation: in phase 1 of the cycle there is usually a visible growing follicle and in phase 2 the corpus luteum, which confirms that ovulation has occurred.
Stage II
Ovulation monitoring
Ovulation monitoring, if the doctor deems it necessary, usually lasts for one or more cycles and consists of determining whether there are normally developing Graafian follicles; it is also possible to assess their number and size (they grow about 2 mm per day) and also to determine the thickness of the endometrium of the uterus.
Ovulation monitoring allows the precise assessment of the very moment of ovulation, thus increasing the chances of pregnancy by planning the timing of intercourse.
If cycle monitoring reveals that a follicle does not rupture (undergoes so-called premature luteinisation) or the follicles grow at an uneven rate, ovulation induction may be indicated.
Stage III
Ovulation stimulation
For the treatment of infertility by assisted reproduction methods, hormonal stimulation is used, which leads to the growth of one (induction of monovulation) or more (induction of polyovulation) maturing ovarian follicles and thus increases the chance of successful treatment.
Ovulation induction is the treatment of choice for women with ovulation disorders.
Stage IV
Surgical treatment
Surgical techniques are available to patients with unsuccessful results of conservative treatment.
Surgical methods include so-called ovarian drilling, sometimes performed in polycystic ovary syndrome, where treatment with assisted reproduction methods has not been successful. The procedure involves a laparoscopic puncture of the ovaries several times.
This type of treatment can only be applied to young women with a high ovarian reserve.
Adhesions and foci of endometriosis can be removed using the laparoscopic method. Occasionally, removal of myomas, polyps in the uterine cavity or hysteroscopic removal of the septum of the uterine cavity may be necessary prior to the insemination and IVF.
Good to know
All you
should know
During a single ovulatory cycle, a woman produces one to two Graafian follicles. This is because, when exposed to hormones, the ovaries are stimulated to produce ovarian follicles containing egg cells.
During the cycle prior to the start of the ovarian stimulation process, the patient may take contraceptive pills. This is aimed at quieting the ovaries and preventing the formation of ovarian cysts. At the end of this cycle, a final decision is made as to the start and type of hormonal stimulation. The greater the number of follicles produced, the greater the chance of pregnancy, but the risk of a multifoetal pregnancy increases. In the case of growth of more than 2 follicles, it is generally not advisable to try to get pregnant (in special selected situations with poor prognosis, pregnancy attempts may be allowed with 3 Graafian follicles present).
The entire stimulation process follows the chosen protocol and is individually tailored to the patient. Hormone stimulation in women uses:
- Clomiphene citrate – used for ovulation disorders in women where partners are fertile. In a normal menstrual cycle, the secretion of gonadotropin-releasing hormone (GnRH) causes the pituitary gland to release FSH and LH, thereby stimulating follicle development and ovulation. Clomiphene has been found to induce ovulation in 75% of non-ovulatory women and 35% of these women become pregnant. Most pregnancies are singleton. The percentage of twin pregnancies is less than 10%. Clomiphene is typically used for 4 to 5 cycles. If the patient does not become pregnant during this time, the next step is to use letrozole or gonadotropins.
- Letrozole – currently, it is a first-line drug for ovulation induction in women with polycystic ovary syndrome.
- Gonadotropin-containing preparations – gonadotropins stimulate the growth of an ovarian follicle or follicles and are usually used in women who have not responded to treatment with letrozole or clomiphene citrate or who have not become pregnant despite achieving ovulation following oral medication. These drugs are also the drugs of choice in women with ovulatory disorders caused by hypogonadotropic hypogonadism. These drugs are produced by extracting active hormones from the urine of postmenopausal women (human menopausal gonadotropin, HMG) or by using genetic engineering methods in special programmed cell lines (recombinant human follicle stimulating hormone, rh-FSH, recombinant human luteinizing hormone rh-LH).
- Human chorionic gonadotropin preparates (HCG) – urine-derived (u-HCG) and recombinant (recombinant human chorionic gonadotropin) preparations. This hormone causes the final maturation of the follicle and the release of the egg, in a manner analogous to natural LH. The medication is usually administered 24 hours after the last dose of gonadotropins
Conservative treatment is available to women with endocrine dysfunction leading to disrupted or absent ovulation.
Anovulation may be caused by a number of factors:
- stress
- poor diet
- abnormal body weight (obesity, underweight)
- sudden body weight changes (fast body weight drop or increase)
- strenuous, excessive physical activity
- polycystic ovary syndrome (PCOS)
- pituitary and hypothalamic diseases
- excess prolactin and other endocrine disorders, including thyroid and adrenal dysfunction
Conservative treatment is intended to achieve ovulation in women presenting with non-ovulatory cycles.
Hormone stimulation is also useful in assisted reproductive techniques to produce multiple follicles.
Contraindications to hormonal stimulation include general poor health, obesity and being overweight, lack of ovarian function, and certain cancers.
Prior to initiating hormone stimulation, you are required to attend a consultation appointment to review your general health, medical history, medications, supplements you take and any other medical factors that may affect the hormone stimulation process.Furthermore, the attending physician may order blood tests including sex hormones, thyroid hormones, AMH and other hormones, and other tests to assess your general health.
A healthy diet, regular physical activity and adequate hydration are important for overall health and preparation for hormonal stimulation. Avoid alcohol, nicotine and other substances that can harm the embryos.
Hormonal medication intake may affect psychological wellbeing; see your physician or therapist if so.
Please note that each hormone stimulation process is unique and may vary according to the patient’s individual needs.
Method success rate
Method success rate
Depending on the cause of infertility and individual patient factors, the success rate of conservative infertility treatment may vary.
Menstrual cycle monitoring, hormonal stimulation, surgical intervention are some of the conservative methods available for the management of infertility.
However, please remember that the effectiveness of each method will depend on the cause of the patient’s infertility. In some cases, where the causes are more complicated, more advanced medical procedures may be required. For this reason, it is always important to consult an infertility specialist physician as they are well-placed to assess the case and recommend appropriate treatment.
Test price list
| First appointment, incl. ultrasound scan |
PLN 350 |
| First appointment, incl. ultrasound scan – Gynecological endocrynology and fertility specialist |
PLN 400 |
| Follow-up appointment |
PLN 250 |
| Follow-up appointment – Gynecological endocrynology and fertility specialist |
PLN 300 |
| Consultation, incl. ultrasound scan, during stimulation |
PLN 200 |
| Consultation, incl. ultrasound scan, during stimulation – Gynecological endocrynology and fertility specialist |
PLN 250 |
Opinions
How patients see us
I would like to wholeheartedly thank the ARTVIMED staff for making our dream of becoming parents come true. Our beloved baby son was born on 15 May this year.
Thanks to the physicians at the clinic, the whole IVF procedure was successful on the first try 🙂 We received the best care at each step. I had the opportunity to meet several doctors at the clinic during my appointments, and each one proved to be an outstanding professional.
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Opinion (Google) |
I highly recommend this doctor. Competent, committed, empathetic. Specific treatment plan. You know you are in good hands.
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Opinion by B. on Dr. Joanna Figuła (Znany Lekarz) |
Thanks to the Doctor, we welcomed our son into the world 2 weeks ago.
We found this doctor after several years of struggling to conceive a child and being treated by specialists who knew nothing about infertility. The doctor immediately outlined a definite plan of action, ordered the right diagnostic tests, and referred us to the hospital for testing. As a result, the treatment progressed in the right direction.[…]
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Opinion on Dr Ewa Posadzka Agnieszka L. (Znany Lekarz) |
The best doctor we could have come across; she managed our pregnancy with great commitment.
Patient and taking every moment to help or clear up doubts if necessary. Thanks to the Doctor, we are parents of a 5-month-old miracle baby. Highly recommended
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Opinion on Dr Agnieszka Wolak Anna (Znany Lekarz) |
Dr Baran is by far the gentlest, most thorough gynaecologist interested in the patient’s concerns that I have ever encountered.
Immense knowledge of endometriosis, the skills to provide complete ultrasound testing for it and the know how to guide a patient dealing with this unpleasant disease. […]
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Opinion on Dr. Rafał Baran (Znany Lekarz) |
I highly recommend pregnancy management. My past experience with other doctors was that there was little to be gained from the appointments, the doctors were reluctant to tell me what they saw, unwilling to answer questions, and Ms Joanna answered every single one, demonstrating an enormous amount of patience. Highly recommended.
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Opinion on Dr. Joanna Figuła Katarzyna (Znany Lekarz) |
Although our little sunshine is already 6 years old, so far, when I look at her, I still have Dr Chrostowski and the Artvimed clinic in my mind… Dr Chrostowski has got that something about him that, when you are in his office, you know that you couldn’t have found a better place. I will always highly recommend ARTVIMED to everyone.
Ps. I still am in awe of how the embryologists work…how they ‘managed’ to create such a miracle… 😉 Thank you for being there
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Opinion (Google) |
Very matter-of-fact doctor; she informs you thoroughly about everything and explains everything comprehensively. She informed me of the treatment plan and was very kind, gentle and understanding.
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Opinion on Dr Katarzyna Doroszewska (Znany Lekarz) |
We would like to thank the entire ARTVIMED Team – our little miracle was born 2 weeks ago. Many thanks are due, in particular, to Dr Posadzka, through whom the right diagnostic work began, and to Dr Chrostowski, who guided further treatment, punctures, and transfer. I also had the pleasure of dealing with most of the doctors during the course of my diagnosis and each one showed a great deal of support and professionalism. We would also like to thank the Embryology Team – without you, our son would not be here. Thank you for the beautiful work of the whole clinic!
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Opinion (Google) |
