Ovulation Induction

WHAT IS OVULATION INDUCTION?

Ovulation is the process by which an egg is released from a mature follicle which has developed on one of the ovaries. In women who have normal regular menstrual cycles, this normally happens once a month. In some women however, follicle maturation and ovulation happens irregularly, rarely and in some cases not at all.

Ovulation Induction is a common first line of treatment for women with such ovulation or menstrual cycle irregularities. It is one of the most straightforward fertility treatments available and simply involves taking oral or injectable medication to stimulate ovulation. The medication is commonly taken at the beginning of the menstrual cycle and the woman’s response is monitored through the cycle using ultrasound. The clinician can then determine when the patient is due to ovulate and therefore the best time for intercourse or insemination.

HOW IS OVULATION INDUCTION ACHIEVED?

There are different protocols, medications and dosages of medication that can be used for ovulation induction, which will be tailored to suit each individual. Your clinician will decide when you will commence medications to stimulate the ovaries and when you will need to be monitored by ultrasound scans and sometimes blood tests.

The fertility drugs that are variously used to achieve ovulation induction include:

  • Clomiphene citrate (Clomid) tablets which are usually taken from day 2 to day 6 of the menstrual cycle. This is used to trick the pituitary gland into producing more follicle stimulating hormone and to therefore stimulate follicle development on the ovary.
  • Follicle Stimulating Hormone (FSH – Puregon/Gonal F) daily injections are used to stimulate the ovary to produce follicles and encourage those follicles to mature.
  • Human Chorionic Gonadotrophin (hCG – Ovidrel/Pregnyl) injections are used when the follicles are mature to initiate ovulation.
WHAT PROCEDURES ARE USED IN COMBINATION WITH OVULATION INDUCTION?

Ovulation Induction is often used to achieve conception in combination with normal sexual intercourse. This is called Timed Sexual Intercourse (TSI) and simply involves the clinician identifying the best time in the cycle for the couple to have intercourse.

In some cases Ovulation Induction is used in combination with Intra-uterine Insemination (IUI). Again following ovulation induction the likely time of ovulation is identified, but in this case, a sperm preparation is injected into the uterus by the clinician. This process involves the partner producing a semen sample (or in some cases a sample of donor sperm being thawed) from which the motile sperm are extracted and concentrated in the laboratory. The woman attends the clinic and the insemination is performed using a thin catheter inserted through the cervix in a procedure very like a pap smear.

ARE THERE ANY RISKS ASSOCIATED WITH OVULATION INDUCTION?

- OHSS (Ovarian Hyper-stimulation Syndrome) – The main risk of ovulation induction is Ovarian Hyper-stimulation Syndrome (OHSS), when a woman overresponds to the ovulation induction protocol and can become very sick. This risk can be minimised through monitoring the treatment cycle with ultrasound scans and sometimes blood tests.

- Multiple Pregnancy – When the ovaries are stimulated by ovulation induction protocols, it is possible for more than one follicle to mature and release an egg at the same time which could in turn result in a multiple pregnancy. It is therefore very important that the cycle is monitored by ultrasound. In some cases it may be necessary to cancel a cycle if too many follicles develop and the risk of a multiple pregnancy is too high.

 


 

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