Ovulation induction is the way we describe the treatment we’ll use to help you if your infertility is caused by poor or absent ovulation which is generally linked with irregular or absent menstrual cycles.
If your doc recommends ovulation induction, then we’ll use hormones to stimulate ovulation and let you know when to lock in some sexy time. While you’re having the hormone treatment, we’ll also need you to pop into the clinic for regular blood tests and ultrasounds.
There are two types of medications we might use to stimulate ovulation. Clomiphene citrate and letrozole, which are both tablets, or injections of follicle stimulating hormone (FSH).
Clomiphene and letrozole both act early in the cycle against the hormone oestrogen, encouraging the pituitary gland at the base of the brain to produce higher levels of FSH than in a cycle with poor or no ovulation. Those higher levels of FSH encourage the follicles to develop in the ovaries. Your doctor would prescribe a five-day course of tablets - usually taken on days two to six or five to nine of your cycle.
Follicle stimulating hormone (FSH) is the hormone that’s needed for the development of the multiple follicles that we like to see in IVF. We can also use it in in smaller doses for ovulation induction. FSH is given by injection. But don’t panic, it’s a fine needle.
If you’re prescribed tablets, often the egg will release (ovulate) on its own and this will be detected on your blood tests. However, if this doesn’t happen, we’ll trigger ovulation once we see on your ultrasound that the lead follicle is the right size. To trigger ovulation, we use an injection of human chorionic gonadotrophin (hCG) – this mimics the natural LH surge that causes an egg to be released.
This trigger process is also what we do if you’ve been prescribed the FSH injections.
Even with the most stalker-like monitoring, sometimes more follicles can reach maturity than we’d really prefer. If that happens to you, your Fertility Specialist will tell you not to have sex as a multiple pregnancy is likely. These pregnancies are high risk – even with twins, complications are much more common than singleton pregnancies. Ovulation induction may be recommended for women who have normal tubes, and whose partners have a normal semen analysis, but who rarely or never ovulate. More on fertility tests.
IUI jumps to the top of the treatment menu for people who have a physical problem with sexual intercourse or a physical problem of the cervix which prevents sperm getting through. It is also sometimes used when donor sperm is needed.
During an IUI cycle, we monitor patients closely with blood tests and ultrasounds and when you are ovulating, we place sperm directly into the cervix using a small, thin plastic tube – this all happens in day surgery and is no more uncomfortable than a pap smear.
Depending on what else is going on with your body, your Fertility Specialist may or may not prescribe ovarian stimulation as part of the IUI treatment. Ovarian stimulation combined with IUI is a common treatment worldwide for unexplained infertility, but it’s not as effective as IVF and has a higher risk for multiple pregnancy so it’s often not the first choice for our baby-making experts. Stimulation-IUI is also not as effective as IVF in cases where there is a low sperm count or endometriosis. It isn’t recommended if fallopian tubes are blocked or if the cause of infertility is unknown. All of this info really means one thing – your baby-making team will make sure you have an accurate diagnosis and then they will design the treatment approach that is right for YOU. More on baby-making meddlers.