What is ovulation induction?

Ovulation induction involves using fertility medications to stimulate growth and release of eggs for fertilization in women having trouble getting pregnant. It has become a basic element of fertility treatment.

It is the initial and simple step in the treatment of subfertility. About 25% of all female infertility is due to ovulation problems. Ovulation induction with hormone stimulation has become an effective treatment that boosts pregnancy success rates.

What are the indications for ovulation induction?

Ovulation induction can help women who do not ovulate at all (anovulation as in PCOS patients) as well as those who may have subtle problems with ovulation to produce more than one mature egg per cycle. Indications include:                                                                               

  1. Woman does not ovulate.
  2. Irregular or infrequent ovulation due to PCOS, abnormal pituitary hormone levels and other causes.
  3. Absence of menstrual periods (called amenorrhea).
  4. Hyperprolactinemia (elevated prolactin serum).
  5. Intra Uterine Insemination procedure.

What are the medications used in ovulation induction?

A variety of hormone-based fertility medications are used to treat a variety of fertility problems related to ovulation like Clomiphene citrate, Letrozole and hormone injections.

What is the process of ovulation induction?

Ovulation induction promotes growth and release of 2-3 eggs and thus increases pregnancy success rates. Treatment starts from the 2nd or 3rd day of the periods (Day 1 is the day of start of the periods). Follicular scans will be performed on 9th -11th day. HCG trigger injection is given when the leading follicle size is 18 mm or more.

Couple will be advised to have intercourse around the time of ovulation. Egg travels into the fallopian tube where it can be fertilized by the sperm.Fertilized egg (embryo) travels back to the uterus and gets implanted. If the embryo implants,women will become pregnant and if it does not get implanted, women will get the periods.

Pregnancy test will be done 2 weeks after ovulation.Women taking injectable medications will need closer monitoring in the fertility clinic

What is the success rate of ovulation induction?

Success depends upon many factors like woman’s age, man’s age, sperm count and quality and other factors. Success rate is approximately 15%.

How many times a woman can undergo ovulation induction?

Women can ideally undergo 4 months of ovulation induction, but can be tried up to 6 months. You could take a break and try naturally in between the treatment cycles.

What are the factors involved in the success of ovulation induction treatment?

Women’s age< 35 years, Man’s age< 40 years, normal semen parameters, patent fallopian tubes and regular sexual intercourse will help in improving the success rate in ovulation induction treatment.

What are the risks and side effects of ovulation induction?

Failure: With ovulation induction, chance of conception is approximately 12-15% per month.The aim of ovulation induction treatment is to provide an opportunity for natural conception. No fertility treatment guarantees success. Women should not get too disappointment when it fails.

Multiple pregnancies:Ovulation induction increases the risk of a pregnancy with twins, triplets or more. Such multiple pregnancies have health risks for mother like pre-term delivery, gestational diabetes and high blood pressure and for the child, low birth weight and developmental problems in case of extreme prematurity.

Ovarian hyper stimulation syndrome (OHSS), in which the ovaries enlarge and become painful, can occur after ovulation induction when the medication dose is higher and when the body is highly sensitive to the medications. Most cases are mild, with bloating, nausea, diarrhoea and abdominal pain.Severe cases of OHSS are rare with ovulation induction.

The medicationsthemselves may produceside effects such as bloating, nausea, hot flashes, blurry vision, headaches and redness, itching and swelling at injection sites.

What happens when women fails to achieve pregnancy after -6 months of ovulation induction treatment?

Women may conceive in between any month while trying naturally, if not women can go ahead with four cycles of Intra uterine insemination (IUI) or directly to IVF treatment depending upon many factors.