In infertility, patients who do not have long follicles need follicle stimulation therapy. The following is a question-and-answer format on what you need to do to help you fully understand ovulation promotion. Which patients need ovulation treatment? Patients with polycystic ovaries, irregular menstruation and no follicular development or abnormal ovulation on ultrasound or cath lab may consider ovulation treatment. What is abnormal ovulation? One or more conditions: 1) persistent absence of mature follicles on the ovaries; 2) failure of follicles to grow to maturity; 3) immature follicles ovulating for several months in a row; 4) failure to ovulate after follicles have grown to maturity, resulting in luteinization. What is the menstrual cycle? How to calculate the ovulation period? Normal menstruation is cyclical. The 1st day of bleeding is the beginning of the menstrual cycle, and the interval between the 1st day of two menstrual periods is called a menstrual cycle. It is usually 21 to 35 days, with an average of 28 days. Ovulation is about 14 days before the next menstrual period and is influenced by estrogen, when the leucorrhea is egg-white like stretched. What are the signs of irregular menstruation? Menstruation is not regular at all; menstrual cycle is shorter than 20 days or longer than 36 days; brown discharge for several days before menstruation; vaginal bleeding in the middle of the menstrual cycle; menstruation lasts for a long time and is not clear. Is irregular menstruation always due to abnormal ovulation? Not necessarily. First of all, we must exclude organic lesions: 1. endometrial lesions, such as endometrial polyps, cervical polyps, chronic inflammation, etc.; 2. uterine fibroids, especially submucosal fibroids; 3. systemic diseases, such as abnormal coagulation function, abnormal thyroid function, etc. 4, uterine adenosis; 5, uterine diverticulum; 6, IUD or contraceptive pill. It can be ruled out by ultrasound or vaginal ultrasound, laboratory tests and gynecological examination. Some people have irregular periods but may also ovulate. It is important to note that in patients with irregular menstruation, pregnancy should be ruled out first. In clinical practice, some people complaining of irregular menstruation are actually having a pre-eclampsia or ectopic pregnancy. If I have a normal period, do I have to ovulate? Not necessarily. About 80-90% of women with normal periods have normal ovulation, but there are a few women with normal periods who do not ovulate. What is the significance of body mass index (BMI)? BMI = weight (kg) ÷ height ² (m). BMI ≤ 24 is considered normal, between 24-25 is considered overweight and > 25 is considered obese. Some patients with polycystic ovary syndrome have obesity that affects follicle development, and half of them can resume ovulation after weight loss. What are the drugs used to promote ovulation? Oral medications include clomiphene and letrozole. Intramuscular medications include urogenic gonadotropins, recombinant gonadotropins and chorionic gonadotropins. How do I take letrozole? How do I monitor my follicles? Take 1 to 2 tablets daily for 5 days starting on day 3-5 of the menstrual cycle. Start monitoring follicles on day 11 of your menstrual cycle with negative ultrasound, either every other day or daily depending on the development of the follicles. How big is a mature follicle? Generally, a follicle is considered mature when it reaches an average diameter of 18-22mm. When do I have a higher chance of conceiving with intercourse? It is easier to conceive when you start having intercourse on alternate days 3-4 days before ovulation. If you are monitoring your follicles, wait for them to mature before having intercourse. Do I need to use progesterone medication after I have used ovulation medication for poor ovulation? The application of ovulation promotion drugs overcomes the problem of irregular ovulation, but it also affects the secretion of the body’s own hormones, which leads to a lack of luteal function after ovulation, so it is better to have luteal support medication. You can take one tablet of Dextran in the morning and one tablet in the evening for 10 to 14 days after ovulation. Why should I use chorionic gonadotropin after the follicles have grown and matured? After the follicles have developed and matured, some patients may not ovulate the mature follicles due to emotion and mood. A single intramuscular injection of chlortetracycline (HCG) 5000 U can be given to mimic the effect of endogenous LH peak and induce oocyte maturation and division and ovulation to occur. If ovulation does not occur, the dose of HCG can be increased to achieve ovulation. Does a “biphasic” basal body temperature mean that ovulation is occurring? In most cases, a biphasic basal body temperature indicates normal ovulation. There is a condition called unruptured follicle luteinization, which means that the follicle is mature and not ovulated, but luteinized, then the basal body temperature is also “biphasic”. What should I use if clomiphene or letrozole is not effective in promoting follicles? If clomiphene and letrozole do not work for 3 months, you should stop using them and use hMG, containing 75 U each of FSH and LH. 50-150 U of hMG should be injected intramuscularly every day or every other day from the second to third day of the cycle until the follicles mature. Ultrasound and blood estrogen levels are required to monitor follicle development during the drug administration. Intramuscular injection of chorionic gonadotropin (HCG) 5000 U is given after follicle maturation to promote ovulation and luteal formation, and progesterone luteal support is used after ovulation.