What Is Ovulation Induction?
Through supervised hormonal therapy, ovulation induction stimulates the development and release of healthy eggs in women who, for various reasons, do not ovulate or experience irregular menstrual cycles. Since its inception, this process has also been employed to promote greater success rates for natural conception by helping a greater percentage of eggs in a woman’s natural ovarian reserve mature fully within a single cycle.
Evidence gathered as recently as the mid-1990s has suggested that even naturally ovulatory women could benefit from inducing ovulation via injectable medications, as has long been common in the processes of in vitro fertilization (IVF) and other assisted reproduction treatments. Although physicians have long associated these drugs with increased risks for increasing the time and cost investments of IVF, ovarian hyperstimulation and multiple gestation, women diagnosed with “unexplained fertility” potentially caused by subtle ovulatory defects have been induced to develop and release two to three mature eggs instead of just one.
A thorough patient evaluation is essential before proceeding with ovulation induction, including a discussion of any pre-existing hormonal disorders and how fertility drugs might affect them. Intrauterine insemination (IUI) virtually always follows the procedure when treating anovulatory woman.
What Qualifies A Patient As A Candidate For Ovulation Induction?
Women With Unexplained Infertility
For roughly 50 percent of couples including a female partner under 35 years of age and 80 percent of those that include a woman more than 40 years old – overall, anywhere from 10 to 20 percent of all aspiring sets of parents – standard fertility testing fails to pinpoint a single reason or even a likely combination of circumstances that continually prevents pregnancy. More than a dozen variables within a woman’s reproductive tract could, with enough deviation caused by any change among a plethora of environmental, internal or genetic factors, render a woman infertile despite an otherwise sound medical history and bill of health.
It only takes one weak link in that complex chain to indefinitely sabotage conception. Many ovulatory women previously diagnosed with unexplained fertility have eventually become pregnant with assistance from ovulation induction, but only a complete examination by your doctor will determine definitively whether your inability to become pregnant is caused by a condition the procedure’s effects can overcome.
Women With Long, Irregular Or Infrequent Cycles
The extent to which conceiving a child depends on pure timing, often goes underestimated. some women regularly experience prolonged or inconsistently timed menstrual cycles, this can make it difficult to time unprotected intercourse so that it coincides with the window when a woman’s body has released at least one healthy, mature egg. Ovulation induction shifts a woman’s periods into a more predictable, steady pattern around which a couple can plan its efforts to become pregnant.
Women Who Are Not Spontaneously Ovulating
For numerous reasons ranging from multiple possible medical or genetic conditions to cancer treatment side effects and hormonal irregularities caused by extremely intense physical training and the duress of an eating disorder, a woman’s body sometimes cannot naturally release or even produce eggs. As with cases of unexplained fertility, your doctor should determine whether your lack of spontaneous ovulation is caused by an impediment ovulation induction can overcome, and if so, which medications are best suited for your body.
Couples With No Male-Factor Infertility
In many instances, thorough testing indicates no fertility issues stemming from a male partner. In the absence of male-factor infertility, ovulation induction is often one of the first treatments recommended to improve a woman’s hormonal and menstrual environment. As stated above, this is an avenue of fertility assistance viable to a large segment of women, regardless of menstrual normality.
Ovulation Induction Treatment Is Not Recommended For:
Women With Tubal Blockage Or Severe Tubal Damage
Even if ovulation induction successfully stimulates your body to develop and release multiple mature eggs, they still must make their way through the fallopian tubes in order to implant in the uterine lining. Without the intervention of IVF , severe tubal damage or blockage will continue to impede pregnancy.
In addition, a blocked or damaged tube should always be monitored for signs of tubal pregnancy. If an embryo implants in the fallopian tube instead of the uterus, the tube can eventually rupture and create a potentially deadly situation with massive internal bleeding. An obstructed tube near the ovaries can also cause a buildup of fluid known as a “hydrosalpinx.” If allowed to back up from the ovaries into the uterus, the toxic liquid can be lethally toxic to any implanted embryos. Whether the other tube remains open or you plan on IVF or IUI, a hydrosalpinx should always be removed before proceeding with plans to become pregnant.
Women With Severe Endometriosis
Unfortunately, even a fully mature egg typically cannot overcome the significant tubal damage and ovarian cysts that almost always cause permanent infertility in this condition’s most severe cases. Studies have shown that ovulation induction can sometimes positively affect infertility following laparoscopic treatment of endometriosis but only with appropriate drug therapy in cases with less than five years of infertility.
How Is Ovulation Induction Performed?
Ovulation induction consists of two major stages following the initial evaluation. During ovarian stimulation, medication in minimal doses will alert your ovaries to create anywhere from one to four eggs. Producing any more than four eggs drastically elevates the risk of a multiple pregnancy but does nothing to improve the actual pregnancy rate. Your doctor will likely prescribe both injectable gonadotropins and a combination of oral medications. The combination is designed to promote healthier mature eggs.
Ultrasound examinations carried out every three to four days and regularly measuring estradiol and progesterone levels in your blood will keep tabs on your egg-containing follicles’ progression toward a range of 16 to 20 mm in size, at which point administration of human chorionic gonadotropin (HCG) will initiate ovulation.
Around 24 to 40 hours after stimulated ovulation, the final stage occurs – IUI.
First, a collected sperm sample will be “washed” by fertilization-enhancing media as soon as possible after being received. A physician will then inject it through a catheter directly through the cervix and into the uterus. The process causes only a mild degree of cramping during its entire three to five minutes from start to finish.
Two days later, you will begin prescribed progesterone supplementation and await a pregnancy test in around 14 days.
What Drugs Are Used?
Clomid (Serophene, Clomiphene Citrate)
Administered orally over the course of five days in doses of 50 to 100 mg per day, this drug “tricks” the body into producing more follicle stimulating hormone . Several days after stopping use, the ovaries experience a surge of luteinizing hormone (LH) that triggers ovulation around 36 hours after the flood hits. Results may vary depending on the patient’s age, existing fertility issues and parameters of semen used. Uncommon immediate side effects may include mood swings, blurred vision in especially rare cases and hot flashes.
Femara Or Letrozole And Other Aromatase Inhibitors
These orally introduced agents are often prescribed as alternatives to clomid with similar results in head-to-head trials. Women who have previously experienced side effects associated with Clomiphene Citrate or Serophene can switch to Femara, Letrozole or another aromatase inhibitor early in the ovarian stimulation cycle starting with doses of 2.0 to 5.0 mg per day over five days to achieve the same desired effect. Doses can safely be increased to 2.5 mg in a subsequent cycle but rarely, if ever, exceed 7.5 mg daily.
Injectable Gonadotropins And FSH Hormone Products
Your doctor may prescribe five to 12 days of self-injected gonadotropins such as Menopur, Gonal F or Follistim in order promote maturation of eggs within their follicles. The optimal dosage to both reduce the risk of OHSS and multiple births and maximize the likelihood of conception varies from one patient to the next, but your doctor will closely monitor your condition with regular hormonal evaluations and ultrasounds to adjust dosing as needed. An HCG injection will then initiate ovulation by mimicking a mid-cycle LH surge. Physicians frequently prescribe these medications to patients preparing for IVF cycles in order to produce as many mature follicles as possible, though success rates can hinge on a number of individual variables. Successful ovulation induction using gonadotropins and IUI typically results in a 15% chance of becoming pregnant with twins, and a lesser chance of conceiving more children.
In other cases, synthetic gonadotropin-releasing hormone (GnRH) analogs and antagonists such as Lupron, Ganirelix, Cetrotide, Antagon are remarkably similar to the hormone released by the hypothalamus in the brain to manage the pituitary gland’s secretion of follicle-stimulating hormone (FSH) and LH, the body’s triggers that activate egg production and ovulation. Their functions are a different story. Whereas Lupron initially ramps up the release of FSH and LH before subsequently suppressing them, Antagon and Cetrotide cut off their production immediately. These GnRH imitators are prescribed to coincide with a gonadotropin regimen in order to maintain strict hormonal control during ovulation induction and lower the cancellation rate for assisted reproduction cycles by as much as 75 percent.
What Is The Success Rate Of Ovulation Induction?
Using the most thoroughly tested fertility medications currently approved by the FDA, this first-line treatment stimulates ovulation in the majority of patients and significantly improves the chances that a mature egg meets a motile, healthy sperm within the fallopian tube.
What Are The Risks & Side Effects?
Ovarian hyperstimulation syndrome (OHSS) poses arguably the most significant health risk your doctor should make you aware of prior to beginning ovulation induction. Although occurring in a small number of patients, over-responsiveness to stimulating medication can cause such severe symptoms as nausea or vomiting, darkened urine, shortness of breath and severe abdominal pain. Notify your doctor upon experiencing any of these symptoms while undergoing this process.
In addition to the side effects listed above, some medications such as clomid have been known to inhibit the uterine lining, potentially impacting efforts to become pregnant. You should also set aside time during your consultation to discuss the possibility that producing multiple eggs through ovulation induction may result in pregnancy with multiples.