Ovulation Induction is a simple process to stimulate egg development and release (ovulation) to improve the chances of conception either through intercourse or artificial insemination (IUI). You’ll take medication (as tablets or through injections) to stimulate your hormones.
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 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. Evidence exists to suggest that there may be an advantage to treating even ovulatory women with fertility medications. This treatment therefore improves the quality and quantity of the ovulation, thus enhancing pregnancy rates.
In ovulatory women, ovulation induction is always combined with intrauterine insemination. Ovulation induction should progress only after a complete and thorough evaluation. All underlying hormonal disorders, such as thyroid dysfunction, should be treated before resorting to ovulation induction with fertility drugs.
How does Ovulation Induction work?
Your ovulation cycle will be confirmed with blood samples to measure hormone levels at specific stages of your 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.
For women who don’t have a normal menstrual cycle, it may take some time to ovulate after starting the medications. Ovulation may occur much later in their cycle (after Day 14).
The Medications used are Clomiphene citrate and injection of Follicle Stimulating Hormone (FSH).
Risk associated with ovulation induction
This 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 hospitalization to manage the pain and other associated clinical findings.
Multiple pregnancy is also a possibility when these medications are used. In general approximately 75% are single, 20% are twins, 5% are triplets and 1% are quadruplets or higher.
The risk of multiple pregnancy 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 your doctor to not give the injection that causes ovulation. This eliminates the risk of any pregnancy (single or multiple) occurring in that cycle.