Ovulation induction is a method of assisted reproduction which is appropriate for the treatment of fertility problems in women who do not have normal ovulation or have no ovulation at all because of hormonal disorders or because of Polycystic Ovary Syndrome.
What is ovulation induction?
Ovulation induction is a simple procedure to help ovulate. In women who have no ovulation at all, this drug therapy aims at releasing a mature egg.
Ovulation induction is usually followed by sexual intercourse but is often part of other therapies such as intrauterine insemination or IVF.
Drug administration stimulates ovarian stimulation in order to increase the number of eggs to be released per cycle so as to maximize chances of conception during sexual intercourse, IUI, or IVF.
Initially, the physician will recommend specific blood tests to measure hormone levels at specific stages of the woman’s cycle. Then, transvaginal ultrasounds will be made to examine the development of the follicles, the thickness and the image of the endometrium.
The ovulation induction usually follows the following procedure:
During the first 2-3 days of the menstrual cycle, blood tests and an ultrasound can be performed to check if the right conditions are in place to initiate the challenge. The next day, the woman begins to receive medication. Depending on the method of inducing ovulation, follicular development is monitored by 2-4 transvaginal ultrasounds and possibly by measuring levels of hormones in the blood.
The process of producing eggs may be delayed in women with unstable menstrual cycles.
When the follicles have reached a satisfactory size, the day of onset ovulation may either be predicted by the sudden increase in LL levels in the blood or may be determined earlier by the administration of choriogonadotropin in the form of an injection causing the Final maturation of the follicles and ovulation. At about 32-36 hours from LH elevation or chorionic gonadotropin injection is an ideal time for the couple to have sexual intercourse or intrauterine insemination.
Duration of treatment
The treatment lasts from 10 to 20 days depending on the treatment protocol used and depending on the response of each woman to the particular method.
The drug most commonly used as the first choice for ovulation induction is clomiphene citrate which causes gentle ovarian stimulation and has no serious side effects. It is given in the form of oral pills for 5 consecutive days at the beginning of the woman’s cycle.
Another way to stimulate the ovaries to induce ovulation is to administer medications called gonadotrophins (such as follicle stimulating hormone-FSH), substances produced by the woman’s own pituitary gland and acting on their follicles, causing them to grow and mature.
Stimulation by this method is applied to women who have no ovulation due to lack of their own pituitary gonadotrophins and to women in whom ovulation induction with clomiphene has not produced satisfactory results.
Gonadotrophins are given daily in the form of injections in small doses beginning on the 2nd or 3rd day of the cycle.When using gonadotropins to cause ovulation, monitoring the woman with successive ultrasounds and measuring the estrogen in the blood should be particularly meticulous in order to avoid the risk of ovarian hyperstimulation syndrome and multiple pregnancies.