Aims of Ovulation Induction
The aim is to stimulate preferably one or two and a maximum of three ripe follicles. When the size of the follicle and the oestrogen level suggests that the follicle is ripe, another hormone, Human Chorionic Gonadotrophin (HCG) is administered which releases the egg. All the couple have to do usually is to have intercourse around the time of ovulation.
We usually obtain about 20% pregnancy rate per cycle, with a small risk of multiple pregnancies (usually only twins) of about 20%.
The risks are that too many follicles may be produced (ovarian hyperstimulation), in which case the cycle is cancelled (the HCG hormone is not administered) and intercourse is avoided. It is very rare for the symptoms of sore swollen ovaries with abdominal fluid (ascites) to develop after OI. You may also be given an option of converting to IVF whereby the clinic can remove the eggs, fertilize them with your husband's sperm and freeze the embryos. These can then be transferred in the next cycle. This is a very good option as you would have spent a lot of money on the injections and it would nice if we could save the cycle for you and still give you the best chance.
After the first cycle if there was ovulation but no conception, the cycle is repeated. If too many follicles were produced, the dose of FSH is kept lower for longer.
Normally, pregnancy occurs in the first 3-4 months of ovulation induction. If not, you would need a re-evauation and might have to progress to more advanced techniques such as IVF or ICSI.
Key Points
Hyperprolactinemia (high prolactin levels) need to be corrected before beginning with ovulation induction. MRI of the pituitary might be needed in case of very high prolactin levels to rule out any tumors in the brain.
Hypothyroidism (low thyroid function) also needs to be corrected before OI. You may consult an endocrinologist for this purpose. If uncorrected, if might lead to failure of treatment and early pregnancy losses and miscarriage.
Serum FSH levels on the 2nd day of periods (spontaneous cycle and with no hormone tablets having being taken in the previous month) are good indicators for egg reserve. Levels of < 8 mIU/ml indicate a good egg reserve and optimal chances of pregnancy. Levels of > 8 miu/ml indicate a low egg reserve and the doctor might suggest medication such as Capsules of DHEA 25mg three times a day for 60-90 days before treatment. Also, these patients need aggressive treatment with high dose FSH injections to hasten the pregnancy process.
Serum AMH levels done at any time of the menstrual cycle accurately reflect egg reserve. If the level is between 2 – 6, it suggests an excellent egg reserve. For levels less than 2, again treatment with DHEA for 2-3 months before treatment is advisable.