Ovulation Induction

Written by: Dr. Mohammed Agdi

Ovulation Induction is usually one of the first treatment options utilized if a woman is struggling to conceive. It is the process of stimulating ovulation by using medications. Women who do not ovulate regularly are good candidates for this type of treatment. Induction of ovulation with gonadotropins requires patient and physician commitment.

The injectable drugs are hormones that your pituitary gland normally produces. Although FSH is the hormone primarily responsible for follicular development, both FSH and LH play a role in the normal development and ovulation of ovarian follicles. LH is normally responsible for triggering ovulation when a mature follicle is present. Each of these drugs acts directly on the ovaries and do not have activities elsewhere in the body. Example:

Gonal F Pen: is given subcutaneously. Gonal F comes in multi-dose Pen (300 – 450 – 900 - 1200 IU).
Menopur: is given subcutaneously. Menopur comes in ampule (75 – 600 – 1200 IU).
Merional: is given intramuscular or subcutaneously. Merional comes in ampule (75 – 150 IU).
Menogon: is given intramuscular or subcutaneously. Merional comes in ampule (75 IU).

HCG (Human chorionic gonadotropin): Its action is to trigger the final maturation of the egg and ovulation. Examples:

Pregnyl-Choriomon-Choragon (5000 – 10000 IU) is given intramuscularly.
Ovidrel-Ovitrelle (250 µg) is given subcutaneously.

Indications for Treatment: In women who do not ovulate on their own (anovulation) like cases of Polycystic Ovaries. It is also used in women who do ovulate on their own like cases of unexplained infertility and endometriosis. These drugs are used to produce more follicles from the ovaries in a controlled fashion and are used alone or with combination with tablets like Clomid and others. In most women, any of the above mentioned drugs may be appropriate to use. However, in certain situations, one drug may be more advantageous to you. The choice of medicines will be discussed at your counseling session prior to initiating therapy.

Monitoring

1. It is essential that close monitoring with ultrasound and sometimes blood tests be done to reduce the chances of adverse consequences and to increase the chances of success.

2. Please call the center when your period starts (day 1 of your cycle with normal flow) to arrange for ultrasound and clinic visit to see the physician. Medicines are usually started on day 2-3 of the cycle. Baseline ultrasound is required before starting the medicine. If your period starts on a weekend, we still can start the medicine between days 3-5 of the cycle; your doctor will determine the starting day after reviewing your case.

3. The ultrasound determines how many follicles are developing and how mature they are, based on their size.

4. After the baseline tests, you will take the medicine 5-9 days then return for an ultrasound and the physician will inform for any adjustments in medicine dosage and return visits, if required, until the follicles are mature.

5. Once we have reached our goals for follicle development HCG will be given to induce the final maturation of the egg and ovulation. Do not take the HCG until you are told to. HCG is given because spontaneous ovulation will occur only in a small number of women treated with these medicines.

6. We generally recommend timing of intercourse in the next 2 days after HCG injection.

7. The earliest pregnancy test can be done is 14 days after the HCG was given. Please call the treatment coordinator to communicate your result of pregnancy test.

Adverse Reactions and Risks to Ovarian Stimulation:

• Local irritation at injection site

• Dizziness, nausea, headaches, mood swings irritability, hot flashes, breast fullness or tenderness

• Ovarian cyst formation/enlargement and twisting

• Ovarian Hyperstimulation Syndrome

• Multiple pregnancy

• Cycle cancellation

Cancellation of the Cycle - Canceling the cycle (not giving the HCG or doing intercourse) can prevent OHSS and multiple pregnancies. At times, this may be the safest way to proceed. Cycles may also be canceled for inadequate response.

If pregnancy occurs, you need to continue on the luteal support medications with the same dose and frequency till 12 weeks or otherwise recommended by your physician. Subsequently, a follow-up visit for pregnancy ultrasound will be arranged.

If pregnancy test is negative, you need to arrange a follow-up visit to see your physician for further discussion of future plan and recommendation.

Frequency of Therapy: 3-6 cycles

Informed Consent for the treatment is essential and has to be completed by both husband and wife.