1. The core principle of ovulation promotion: activating the "sleeping follicle"

Women's ovaries reserve about 400 mature eggs, but only one dominant follicle can develop and ovulate in the natural cycle, and the rest are blocked and apoptosis due to hormone regulation. In vitro therapy simultaneously activates these "sleeping follicles" through exogenous ovulation-inducing drugs (such as Nafen, Prirican, etc.). Multiple eggs can be obtained in a single cycle, significantly improving the matching rate of high-quality embryos.
2. Start time of different emission promotion plans: Key decisions that vary from person to person

.1. Routine regimen: Start at the beginning of menstruation (applicable to 80% of the population)
·Long plan: Start the injection on the 14th day after the downtone (i.e., the 3rd day of menstruation) and last for 9-15 days.
· Antagonist regimen: Initiated on the 2nd to 3rd day of menstruation, and completed within 8 to 12 days for ovulation induction.
· Micro-stimulation regimen: Start taking the medication on the 3rd to 5th day of menstruation, and eggs are retrieved on the 7th to 8th day.
· Advantages: During the follicle recruitment phase, the state of the ovaries is stable, and the response to medications can be highly predictable.
2. Promoting ovulation during the luteal phase: tapping the potential of "second wave follicles"
·Applicable population: People with reduced ovarian function and need to save embryos.
· Timing: The procedure should be initiated 1-3 days after ovulation or egg retrieval, and the second round of egg retrieval can be completed in about 10 days.
· Scientific basis: 27% of women experience 2-3 surges in follicular growth during their natural cycle. There are also groups of immature follicles remaining during the luteal phase.

3. Random start options: special options for emergencies
Applicable scenarios: Cancer patients have sudden fertility preservation needs before chemotherapy.
Procedure: Ignoring the menstrual cycle, initiating ovulation stimulation immediately, and completing egg retrieval within 72 hours.

3. Four core bases for individualized decisions

nOvarian reserve function
·AMH value: >1.1ng/ml preferred long regimen;<0.7ng/ml recommended microstimulation.
· Number of If there are more than 5 follicles on both sides, the antagonist regimen should be used; if the number is less than 3, luteal-phase stimulation is required.
·<35 years old FSH<10mIU/ml: Long regimen (average number of oocytes retrieved is 12).
·<35FSH<10mIU/ml:(12).
·≥40FSH>15mIU/ml:/().
·Polycystic ovary syndrome: Antagonist regimen (60% reduction in the risk of OHSS).
· Polycystic ovary syndrome: Antagonist therapy reduces the risk of OHSS by 60%.
· For those who require fresh embryo transfer: Avoid ovulation induction during the luteal phase (as the entire embryo needs to be frozen).
·The antagonist regimen lasts for about 15 days, with low cost and fewer follow-upvisits
·The ultra-long plan requires 1-2 months of pretreatment and is suitable for repeated planting failures.
· The ultra-long-term solution requires 1-2 months of preparation time. It is suitable for those who have experienced repeated failures in planting attempts.

4. Injection time details: optimization accurate to hours

Dailyfixed window: 8:00-10:00 a.m. injection is appropriate (during the peak period of human metabolism, the drug absorption rate is increased by 20%).
Error handling: If the dosage is missed for less than 2 hours, it can be replenished later. If the omission lasts for more than 2 hours, ultrasonic monitoring is required to adjust the dosage accordingly.
Timing of HCG injection: HCG should be administered 36 hours after the last ovulation-stimulating injection. The exact time must be precise to avoid premature ovulation.

5. Expert consensus: Avoid three major cognitive misunderstandings

"The sooner the emission promotion starts, the better"
→ Initiation after day 5 of menstruation may reduce follicular synchronization (except for long regimens).
→ More than 12 days later can easily lead to overmature follicles and reduce fertilization rate.
→ Over 12 days, it’s easy for the follicles to become overripe, resulting in a decrease in the fertilization rate.
→ There was no statistical difference between the pregnancy rates of genetically modified FSH (Rufenafen) and urine-derived FSH (such as Lishenbao).
There is no statistical difference in the pregnancy rates between recombinant FSH (such as Enafil) and urinary-derived FSH (such as Recombinate).
6. Clinical Recommendations: Guidelines for Scientific Pregnancy Preparation Action
Preprocessing

preparation
Supplementing Coenzyme Q10 (600mg/day) one month before the promotion of ovulation improves egg mitochondrial function.
One month before ovulation, it is recommended to take 600 mg of Coenzyme Q10 daily to improve the function of egg mitochondria.
Ultrasound + estrogen testing every 2-3 days to dynamically adjust the dose (avoid OHSS).
Perform ultrasound and estrogen tests every 2-3 days, and adjust the dosage dynamically to avoid OHSS.
Protein intake>60g/day (eggs/fish and shrimp)+ Avoid strenuous exercise.
Protein intake should be greater than 60 grams per day (through eggs, fish, and shrimp). It’s also important to avoid intense physical activities.
Authoritative statement: Professor of the Reproductive Center of Peking Union Medical College Hospital emphasized that "there is no better plan, only the most suitable plan."
:,“,”.It is recommended that first-time test tube recipients seek medical treatment as soon as possible on the second day of menstruation, and establish a path through three assessments: AMH, six hormone items and antral follicle count.