Ovulation Induction (OI)
If a woman has attained puberty and does not ovulate by herself, ovulation is induced with drugs. The lifestyle habits, like immoderate alcohol consumption, smoking, stress, fluctuations in weight and Polycystic Ovarian Syndrome (PCOS) are the general causes of failure in ovulating resulting in infertility.
There may be other fertility issues too, that include the thyroid gland, pituitary gland disorders and high prolactin levels. In certain cases, ovulation failure may be because of the ovarian failure. This may happen after the treatment for cancer or may be because of the beginning of the menopause.
If case you are a woman having irregular periods, follicle tracking is done with the help of ultrasound scans and your hormones are examined. These assessments may help your treating doctor to know your most fertile time of the month to improve the chances of achieving pregnancy naturally.
Much before your ovulation problems can be cured; it is pertinent to carry out some tests to know the cause. These tests may include:
- An ultrasound scan of your ovaries and the uterus
- Blood tests to determine the range of your hormones like prolactin, thyroid, LH, FSH, Testosterone and other male hormones like androgens.
In case of high FSH (> 10) concentration level and low AMH concentration level, if measured at the beginning of your menstrual cycle, you are prone to ovarian failure. In such cases, fertility treatment does not work successfully.
If ovulation does not happen, medications may be given as your menstruation begins to help stimulate egg production. In case orally taken pills are not effective, then higher potency medicines may be injected to stimulate your egg production in the ovaries.
Ovulation is induced by using one of two main drug therapies:
- Clomiphene, also known as Clomid, tablets enhances the follicle stimulating hormone (FSH) production by the pituitary gland. Sometimes, alternatives such as, Tamoxifen and Letrozole tablets, are used. The therapy helps in the egg growth. One tablet of 50 mg is usually given each from the 2nd to the 6th day of your periods. If your menstrual cycle is irregular, your periods are induced by giving Type “O”, Norethisterone tablet.
- Gonadotropins: The featured element of this therapy is Follicle Stimulating Hormone (FSH). And, these are normally given by injection. Examples of these hormonal injections are Gonal F, Menopur and Puregon. These hormonal injections are given every day beginning with a dose of 75 IU each day.
The response to these hormonal drugs is observed by ultrasound scans. After the follicles have gained an appropriate size, either bed-partnering is advised or hCG injection is given that facilitates the copulation timing and attaining pregnancy. Or, Intrauterine Insemination (IUI) is performed.
The responses to these treatments vary from individual to individual and are generally unpredictable. In case the response, during the monitoring, is found to be too weak or too strong, the cycle may have to be cancelled and started again appropriately.
In case the response to the drugs is found to be satisfactory, treatment generally is continued for six cycles. And, these treatment cycles are performed one after the other without giving a break.
The potential side effects are largely related to the drugs.
- In about 10% of cases, patients undergoing treatment with Clomiphene, there is a chance of bearing twins.
- And, this percentage goes up to nearly 20% in the patients undergoing treatment with gonadotropins.
- The percentage of bearing triplets are only in around 1% of cases.
Other treatments for women having Polycystic Ovary Syndrome (PCOS)
Women having PCOS generally have difficulty in ovulating. In such cases, Clomid is given as the first line of treatment. The response this hormonal therapy has usually been found to be encouraging.
However, two other treatment choices may also be used:
This medicine is useful in the treatment of Diabetes. The women having PCOS get greatly benefitted with this and their ovulation improves considerably. This happens because PCOS is known to have an effect on insulin and glucose metabolism.
This is a surgical procedure wherein a laparoscopy is needed to be carried out. Four holes measuring 4mm in length are drilled into each of the two ovaries that help improving ovulation.
In about 60% to 85% percent of women having PCOS, the procedure triggers natural ovulation. This is a pervasive procedure that has all the risks of laparoscopy. The procedure rarely causes forming of scar tissue or adhesion in the ovarian region.