Ovulation
Induction

Procedure Risk Factors

Ovulation Induction (OI) is a simple process to stimulate egg development and release (ovulation) them to improve the chances of conception either through intercourse or artificial insemination (IUI).

This treatment uses medication (tablets or injections) to stimulate hormones, therefore, improves the quality and quantity of the ovulation, thus enhancing pregnancy rates.

A normally ovulating woman releases one egg per cycle that has a chance to fuse with the sperm and develop into an embryo. However, some women do not ovulate on their own; typically women with irregular menstrual cycles. Ovulation induction in these women is used with the goal of producing a single, healthy egg.

Other women may be ovulating regularly but are unable to conceive. These women with ‘unexplained infertility’ may have subtle defects in ovulation. Ovulation induction in these women is used to increase the number of eggs reaching maturity in a single cycle in order to increase the chances of conception.

Procedure

Ovulation Induction Procedure

01

Assessment

Before ovulation problems are treated, it is important to undertake certain tests to establish the cause.

DISCOVER
Assessment
Before ovulation problems are treated, it is important to undertake certain tests to establish the cause. These tests include

  • An ultrasound scan of the ovaries and womb
  • Blood tests to measure a range of hormones including Thyroid, Prolactin, FSH, LH, Testosterone and other androgens (male hormones)
  • It is also important to ensure that the ovary is capable of responding to the drug treatment


If the FSH concentration level measured at the onset of a period is high (>10) and the AMH concentration is low, ovarian failure is likely to happen. In such cases fertility treatment is less successful.

02

Stimulation

The ovaries are stimulated with medications to promote the growth of follicles containing eggs.

DISCOVER
Stimulation
The ovaries are stimulated with medications to promote the growth of follicles containing eggs.

CLOMIPHENE CITRATE (CLOMID)
An oral medication used to induce ovulation by encouraging the body to produce more follicle stimulating hormone (FSH).

This is most commonly used if a woman has irregular or long menstrual cycles.

FOLLICLE STIMULATING HORMONE (FSH)
Hormone injections of FSH can be used to stimulate the number of follicles that develop in the ovary and therefore stimulate the number of eggs that are ovulated during a cycle.

03

Trigger

After the development of follicle, another injection of synthetic human chorionic gonadotropin (hCG) hormone

DISCOVER
Trigger
After the development of follicle, another injection of synthetic human chorionic gonadotropin (hCG) hormone can be used to trigger the release of the eggs from the follicles.

The fertilization window is for 36 hours from the time of trigger.

04

Monitoring

Ovulation cycle will be monitored closely with blood samples to measure hormone levels at specific stages.

DISCOVER
Monitoring
Ovulation cycle will be monitored closely with blood samples to measure hormone levels at specific stages of menstrual cycle along with a transvaginal ultrasound to see the development of follicles in the ovaries and the thickness and appearance of the lining of the womb.

05

Insemination

Near the time of ovulation, specialists will advise the most appropriate day to have sexual intercourse

DISCOVER
Timed Intercourse or Artificial Insemination
Near the time of ovulation, specialists will advise the most appropriate day to have sexual intercourse to maximise the chance of pregnancy or to perform an intrauterine insemination (IUI) where prepared sperm is inserted into the uterus.

## For women who face the problem of an irregular menstrual cycle, their ovulation time may vary. In fact, it is quite common for ovulation to occur later in their cycle (after Day 14). One must, however, continue to go for monitoring until one ovulates.

Ovulation Induction

Risk Factors

  • Ovarian Hyperstimulation Syndrome

    Ovulation induction includes the possibility of overstimulation, called ovarian hyperstimulation syndrome, or OHSS. OHSS is reported to occur in approximately 1% of cycles. This is associated with enlarged ovaries, abdominal pain and collection of fluid within the abdomen.

    In extreme cases, it may require hospitalisation to manage the pain and other associated clinical findings.

  • Multiple Pregnancies

    Multiple pregnancies is also a possibility when these medications are used. In general, approximately

    • 75% are single
    • 20% are twins
    • 5% are triplets
    • 1% are quadruplets or higher


    The risk of multiple pregnancies increases with the number of mature follicles that are seen on ultrasound examination of the ovaries. When many mature follicles develop, the decision can be taken together with the doctor to not give the injection that causes ovulation. This may eliminate the chance of any pregnancy (single or multiple) occurring in that cycle.