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 suggests that the follicle is ripe, another hormone, Human Chorionic Gonadotrophin (HCG) is administered which releases the egg. The couple is then advised to have intercourse around the time of ovulation.
The chance of a pregnancy with
simple ovulation induction is about 20% 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 Coenzyme Q, L-Arginine, etc 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 pre-treatment as above for 2-3 months before treatment is advisable.