Infertility impacts numerous individuals and can arise from male, female, or unexplained factors.
In the case of female-related infertility, issues with ovulation can play a significant role. Approximately 25% of infertile women experience challenges with ovulation.
Ovulation induction treatment involves the utilization of fertility medications to address this concern.
This article aims to provide comprehensive insights into the topic of ovulation induction treatment, shedding light on its various aspects.
What is Ovulation?
Ovulation is a crucial event that occurs during the menstrual cycle, involving the release of a mature egg from the ovary.
After being released, the egg awaits fertilization by sperm within the fallopian tube. If fertilization occurs, the resulting fertilized egg implants itself in the uterus.
Ovulation typically takes place around day 14 of the menstrual cycle.
How does Ovulation occur?
Ovulation is a complex process influenced by the rise and fall of levels of various hormones.
It begins with the release of follicle stimulating hormone (FSH) from the pituitary gland in the brain. FSH stimulates the growth and development of ovarian follicles.
These follicles, in turn, produce hormones that provide negative feedback to the brain, preventing the release of additional FSH.
As a result, only one egg fully matures while the development of multiple eggs is restricted.
Once the egg is matured, it signals the brain to release luteinizing hormone (LH). The surge of LH triggers ovulation, causing the mature egg to be released from the ovaries.
Throughout this process, the uterine lining is maintained by estrogen and progesterone, which are necessary for embryo implantation.
Ovulation Induction Treatment
Ovulation Induction is a type of fertility treatment for women.
What is Ovulation Induction Treatment?
Ovulation Induction Treatment is a procedure that involves the use of medication to stimulate a woman’s ovaries, encouraging them to produce multiple mature follicles and ova.
It is primarily utilized for women experiencing difficulties with ovulation. This treatment not only facilitates ovulation but also supports the growth and development of ovarian follicles.
Additionally, it can be employed to trigger the development and release of multiple eggs simultaneously.
The treatment is followed by performing intercourse or intrauterine insemination (IUI) in order to conceive.
Who Needs Ovulation Induction?
Ovulation Induction is needed by women of reproductive age who desire to conceive but are facing ovulation problems.
It is particularly beneficial for women experiencing irregular menstruation, where ovulation occurs less frequently than once every 35 days.
It is also essential for those with anovulation, a condition characterized by the absence of ovulation, as well as for women with oligoovulation, where ovulation is highly unpredictable.
It is important for these women to have healthy fallopian tubes, a normal uterine cavity, and a male partner with a normal sperm count in order to undergo this treatment.
Ovulation Induction can be achieved using medications that stimulate regular ovulation.
Additionally, it is useful for patients without any specific disorders who wish to stimulate the ovaries to produce multiple eggs simultaneously, thereby increasing the chances of pregnancy. This approach is known as controlled ovarian stimulation (COS).
Ovulation Induction is commonly employed in women with polycystic ovary syndrome (PCOS), endometriosis, or unexplained infertility.
Before Ovulation Induction Process
Before the ovulation induction process, several important steps are taken to assess the medical and reproductive history of the individual.
Additionally, ultrasound imaging is used to obtain images of the ovaries and womb, providing valuable information on the follicles that are most likely to ovulate.
Blood tests are conducted to measure hormonal levels, including FSH, LH, thyroid, prolactin, testosterone, and other androgen levels.
These tests help detect hormonal imbalances and evaluate ovarian function and ovarian reserve.
Furthermore, another test is performed to ensure the capacity of the ovary to respond to drug treatment.
These comprehensive assessments and tests are crucial in determining the most appropriate course of action for inducing ovulation.
Process of Ovulation Induction
The process of Ovulation Induction involves 3 main steps.
1. Egg Development
Egg development, an essential step in the process of ovulation induction, occurs within the ovary in fluid-filled sacs known as follicles.
While this process takes place naturally in some women, others may require the assistance of fertility drugs to support the growth of the follicle and egg.
To monitor this development, ultrasound and blood tests are utilized.
Ultrasounds enables the measurement of follicle growth, while blood tests provide crucial information on the levels of hormones such as estradiol (E2), progesterone, and luteinizing hormone (LH).
These monitoring techniques play a vital role in assessing the progress of egg development during ovulation induction.
2. Ovulation Induction
During the process of ovulation induction, the first step is to identify a matured follicle through ultrasound imaging.
Once a mature follicle is detected, a drug is administered to trigger the process of ovulation. This drug stimulates the release of the egg from the ovaries.
As a result, the egg is released and travels into the fallopian tube, where it has the potential to be fertilized by sperm.
This step in the process of ovulation induction plays a crucial role in facilitating the release of the egg, increasing the chances of conception.
3. Insemination
In the process of ovulation induction, insemination is an important step that can be carried out through two different methods.
The first method is timed intercourse, where couples are recommended to engage in sexual intercourse either on the day of ovulation induction or two days later. This allows for the possibility of natural fertilization.
Alternatively, in some cases, intrauterine insemination (IUI) may be used.
IUI is an artificial insemination technique in which prepared sperm is introduced into the uterus, typically carried out 12-36 hours after the trigger of ovulation.
Both methods aim to increase the chances of successful fertilization by bringing the sperm closer to the released egg during the optimal fertility window.
Ovulation Induction Medications
There are two main types of ovulation induction medications
Oral Medications
Oral medications are considered the first line of treatment for women experiencing ovulatory problems.
Clomiphene Citrate
Clomiphene citrate (Clomid) is a commonly used medication for promoting follicular development in ovulation induction.
It works by inhibiting receptors for estrogen in the hypothalamus, which removes the negative feedback of estrogen on follicle-stimulating hormone (FSH) production.
Consequently, the pituitary gland produces higher levels of FSH, leading to the development of one or more follicles.
As the follicles grow, they secrete estrogen, causing its levels to rise in the bloodstream and triggering the release of luteinizing hormone (LH).
This LH surge then prompts the release of the egg(s) from the dominant follicle(s).
The standard dosage for Clomiphene citrate is 50 milligrams (mg) of clomiphene per day, taken for five consecutive days starting from the 2nd to the 6th day of the menstrual cycle.
Tamoxifen, another anti-estrogen drug with a similar structure to Clomiphene citrate, can also be used for ovulation induction.
Aromatase Inhibitors
Aromatase inhibitors, such as letrozole and anastrozole, are oral medications used for ovulation induction.
These tablets work by temporarily decreasing estradiol levels in the body, which leads to increased production of follicle-stimulating hormone (FSH) by the pituitary gland.
The typical dosage of aromatase inhibitors is 2.5–5 mg daily for five days, starting from the second to the fifth day after the onset of menstruation.
During treatment, follicular development and maturation are closely monitored using ultrasounds and hormone tests to minimize the risk of multiple gestations.
Aromatase inhibitors are particularly beneficial for women with specific ovulation disorders, such as polycystic ovary syndrome (PCOS).
Injectable Medications
Injectable medications for ovulation induction are typically considered when oral tablets have proven ineffective in stimulating ovulation.
This method carries the risk of releasing multiple eggs, increasing the chances of multiple pregnancies.
Consequently, careful monitoring is essential both before and after administration of these medications.
This monitoring involves the use of ultrasound and blood work to ensure the proper response to the medication and to determine the optimal timing for fertility procedures.
Gonadotropins
Gonadotropins are injectable medications used for ovulation induction and can contain follicle-stimulating hormone (FSH) or luteinizing hormone (LH), either alone or in combination.
Examples of gonadotropins include Menopur, Gonal F, and Bemfola T.
These medications stimulate the development of multiple follicles in the ovaries, increasing the chances of ovulation and pregnancy.
Gonadotropins are particularly important for women whose pituitary gland does not produce enough FSH and LH naturally.
Typically, a daily dose of 75 IU is injected on the second or third day of the menstrual cycle. The stimulation usually lasts for seven to 12 days but can be extended as needed. 4
Human Chorionic Gonadotropin (hCG)
After the administration of medications to promote follicular growth during ovulation induction, ovulation is triggered by the injection of human chorionic gonadotropin (hCG).
hCG has a chemical structure and function that is similar to luteinizing hormone (LH).
Consequently, the administration of hCG mimics the natural LH surge that occurs in the body, inducing ovulation.
Prior to administering the hCG injection, it is important that the lead follicle(s) measure at least 16 to 18 millimetres in diameter.
The injection of hCG prompts the dominant follicle to release its egg and initiate ovulation. Typically, ovulation occurs approximately 36 hours after the hCG injection is administered.
Other Medications
Bromocriptine or Cabergoline
Bromocriptine or Cabergoline are medications used for ovulation induction in cases where irregularities or absence of ovulation are caused by high levels of prolactin released by the pituitary gland.
Hyperprolactinemia, characterized by higher-than-normal blood levels of prolactin, can inhibit the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), leading to problems in follicular development.
These medications, Bromocriptine or Cabergoline, are utilized to treat hyperprolactinemia, thereby promoting the induction of ovulation.
GnRH Analogs
GnRH analogs are synthetic hormones that closely resemble the natural GnRH hormone.
The GnRH hormone stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are responsible for egg production and ovulation.
However, GnRH analogs work by blocking the effect of GnRH on the pituitary gland in the brain. This prevents ovulation from occurring spontaneously and enhances egg production.
By using GnRH analogs, hormonal control of ovulation induction is improved, reducing the likelihood of cycle cancellations.
Examples of GnRH analogs include Lupron, Ganirelix, Leuprolide Acetate, Antagon, and Cetrotide.
Risks of Ovulation Induction
Ovulation induction, while generally considered a safe procedure, does carry certain risks.
Side Effects of Medication
Ovulation induction carries the risk of medication side effects.
Clomiphene citrate, a commonly used medication, can lead to side effects such as headaches, depression, blurred vision, mood swings, and pelvic discomfort.
Additionally, there is a potential link between Clomid use and fetal abnormalities, ovarian neoplasms, or cancer.
Aromatase inhibitors, another type of medication used for ovulation induction, may cause hot flashes, changes in cervical mucus, headaches, breast tenderness, bloating, and mood changes.
Adverse reactions to gonadotropins, another class of medications, may include breast tenderness, swelling or irritation at the injection site, mood swings, depression, pelvic discomfort, and bloating.
Ovarian Hyperstimulation Syndrome (OHSS)
Ovarian Hyperstimulation Syndrome (OHSS) is a serious risk associated with ovulation induction using hormonal therapy.
It involves an exaggerated response of the ovaries to the administration of excess hormones.
Symptoms of OHSS may include abdominal pain, bloating, nausea, vomiting, and diarrhoea. The ovaries become enlarged and painful due to overstimulation by the hormones.
In severe cases, OHSS can lead to rapid weight gain, severe pain, shortness of breath, blood clots, and decreased urine output.
It is important to monitor patients closely during ovulation induction to detect and manage OHSS promptly.
Multiple Pregnancies
Multiple pregnancies are a risk associated with ovulation induction.
This process stimulates the development and release of eggs from the ovaries for fertilization.
However, if more than one egg matures and is released, there is a possibility of multiple embryos being fertilized and implanted. This can result in the birth of twins or triplets.
Multiple pregnancies carry a higher risk compared to singleton pregnancies, including an increased likelihood of preterm birth, low birth weight, gestational diabetes, and preeclampsia.
It is essential to closely monitor and provide appropriate care for women who conceive multiple pregnancies through ovulation induction.
How Successful is Ovulation Induction?
The success of ovulation induction varies depending on several factors, including the type of prescription, the woman’s diagnosis, her age, and the presence of other fertility issues.
In a young and healthy couple with no other fertility concerns, the chance of achieving pregnancy through ovulation induction is approximately 20 percent each month.