Ovulation Induction

What is ovulation induction?

Ovulation induction involves the stimulation of the ovaries to produce an egg. It is suitable for women who are failing to ovulate but have normal fallopian tubes, where male partners have normal semen quality.

There are a number of reasons why you may not be ovulating. The most common cause is polycystic ovarian syndrome (PCOS). If ovulation induction is carried out, intercourse is timed to coincide with the release of the egg.

How is it performed?

Following a consultation, you will be prescribed a course of drugs to stimulate your ovaries. During your ovulation induction cycle, you will have ultrasound scans and blood tests to monitor the egg development. If you respond to medication, a number of eggs will begin to grow at the same time. The number of eggs that develop will depend on the capacity of your ovaries and the dose of stimulation. This will be identified during an ultrasound scan examination. You will then be given instructions in order to time the release of the egg accurately.

What medications are used to stimulate ovulation?

There are essentially two types of medications used to stimulate the ovaries. These are:

• Clomiphene citrate tablets (Clomid): Usually taken for five days in a cycle starting from the second day of the menstrual bleeding. If a patient has no regular periods, it can be started randomly or after a withdrawal bleed manufactured by medication. Clomiphene works at the level of the central nervous system (pituitary gland in the brain), where signals to produce eggs (Follicle Stimulating Hormone-FSH) are generated.

  These tablets cause the stimulation of the pituitary gland to produce higher levels of FSH hormone. This increased level of FSH hormone can lead to the production of more than one egg at a time, which increases the risk of multiple pregnancies to around 10%.

• Follicle Stimulating Hormone (FSH) injections: This hormone directly stimulates the ovaries to produce eggs. It is normally produced by the pituitary gland in the brain. The FSH hormone is available in injectable format. If FSH is injected to a woman it can stimulate one or more eggs to develop within 12-14 days.

  Ultrasound scan examinations are carried out during the stimulation to assess the response. The size and the potential number determine the timing of the release of the egg(s). Only when ready, a trigger injection is used.

How many times ovulation can be induced and why

Ovulation induction with Clomiphene citrate should not be used for more than six cycles in a life time due to possible increased risk of ovarian cancer. Statistically, most pregnancies occur within the first 3 cycles of use of Clomiphene.

Induction of ovulation by injection of FSH can be used safely provided there is no evidence of hyperstimulation. Its cost and relative success rates however need to be compared to the success of IVF treatment before deciding on the number of cycles of treatment. Each patient/couple needs to be managed based on her/their specific circumstances.

Side effects

• Hyperstimulation and multiple pregnancy Any stimulation of ovulation can cause more than on egg to develop. This in-turn increases the risk of a multiple pregnancy. Development of more than 3 eggs at the same time however could increase the risk of high order multiple pregnancy. In such cases of multiple egg development the treatment cycle may need to be cancelled for the re-adjustment of the dose of stimulation.

• Ovarian Hyperstimulation Syndrome (OHSS) Excessive stimulation of ovaries can very rarely lead to the production of multiple eggs. Again, your treatment may need to be cancelled if this occurs. Your consultant will discuss the effects of this very rare event during your appointment.

• Clomiphene citrate rarely causes migraine headaches and/or blurred vision. Occasionally mood swings have been reported.