Ovulation Induction

Info on Ovulation Induction from a Dubai Fertility Clinic

Ovarian induction is the process to stimulate ovulation (production and release of eggs from a woman) by medication. This is used for women who have difficulty conceiving as their ovaries do not release eggs. Medications can be used to either cause ovulation in a patient who does not ovulate regularly or to cause multiple eggs to be developed and released. There is approximately 25% of infertile women who have pelvic pain2problems with ovulation. By helping these women to ovulate regularly, it increases their chances of pregnancy. These medications are called “fertility drugs” and may also improve the endometrium (lining of the womb or uterus) which is required for pregnancy.

Ovarian induction can help women who have irregular periods as they are likely to have ovulatory dysfunction by helping them to have regular ovulation. Some ovulation problems include: polycystic ovarian syndrome (PCOS) – a hormonal condition which causes the eggs to not be released, ovaries that do not respond to hormones that help the maturation and release of the egg (luteinizing hormone (LH) and follicle stimulating hormone (FSH)), thyroid problems, eating disorders, extreme weight gain and weight loss.

Before fertility drugs are given to patients, doctors often use a hysterosalpingogram (HSG) to make sure that the fallopian tubes (tubes for the fertilized egg to travel into the womb for implantation) are unblocked. Patients who have a blocked tube may have an ectopic pregnancy (pregnancy that occurs outside of the uterus) and can be dangerous. Many women are suitable candidates for ovulation induction. Women who have ovulation issues and those with unexplained infertility can be treated to increase the number of eggs released. A possible complication that may occur is Ovarian Hyperstimulation Syndrome (OHSS).

Some of the commonly used fertility drugs includes:

  1. Clomiphene Citrate: this medication is commonly used to stimulate the maturation and release of eggs. The standard dose is 50-100 milligrams clomiphene(mg) every day for 5 consecutive days. Treatment starts usually on the second to fifth day after menstruation begins. Chances of success depends on the age of the patient, health condition and quality of the semen. The chance of twins is 6-10% and chance of triplets is 1% or less.
  2. Aromatase inhibitors: Used to temporarily decrease estrogen levels in the body which leads to the body producing more follicle stimulating hormone (FSH). FSH is used to help in the production and maturation of eggs. Drugs in this class include letrozole and anastrozole. Studies show that pregnancy rates are similar to Clomiphene Citrate.
  3. Other drugs that can be used are insulin sensitizing drugs – Metformin, gonadotropins, human chorionic gonadotropin (hCG), bromocriptine or cabergoline, gonadotropin-releasing hormone (GnRH) and GnRH Analogs.

Long term studies have not found any association of increased birth defects with clomiphene citrate and gonadotropins. There is also no evidence associating an increased ovarian risk with clomiphene citrate, gonadotropins or aromatase inhibitors.

 

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Overview of Ovulation Induction with Artificial Insemination

Ovulation induction, also known as controlled ovarian hyperstimulation (COH), is used to improve chances for pregnancy. Ovulation induction is often used before intrauterine insemination (IUI) or in vitro fertilization (IVF). The procedure involves the controlled stimulation of the woman’s ovaries by use of medications. This increases the number of eggs that can be fertilized.

Who is a candidate for ovulation induction?

Ovulation induction can be used for couples who have:Fertility Clinic Dubai

 

  • Cervical factor infertility
  • Unexplained infertility
  • Mild endometriosis
  • Male factor infertility
  • Anovulatory infertility
  • Persistent infertility in spite of other treatments

 

What medications are used with ovulation induction?

Ovulation induction allows for precise timing of artificial insemination, where sperm are placed into the uterus through the cervix. Medications will induce ovulation of many eggs. Clomid (clomiphene citrate) is an oral medication used for this procedure. An injectable medication can be use, containing follicle-stimulating hormone (FSH) or human menopausal gonadotropins (hmg) which induce multiple egg development. Human menopausal gonadotropin is given at the time selected by your doctor to mature the eggs and bring on an ovulatory response.

Are ovulation induction medications safe?

FSH, hmg, and Clomid all have been used extensively and are proven safe and effective when administered at a certified fertility clinic. No increase in birth defects and congenital abnormalities has been associated with any of these medications. You will also receive GnRH antagonist by daily injection to enhance the ovarian response. The side effects of Clomid include hot flashes, headaches, mood changes, and vaginal dryness.

Do ovulatory stimulation drugs work?

Clomid with IUI has an 8-10% success rate per cycle when used for unexplained infertility of 3 years duration, with only an 8% chance of multiples (twins, triplets, etc.) Gonadotropin with IUI has a 15-18% success rate when used for unexplained infertility of 3 years duration, with a 15% chance of multiples.

What can I expect during ovulation induction therapy?

During the time you are takin medicines to induce ovulation, you will be carefully monitored to improve success of pregnancy and ensure your safety. In addition to a clinical examination, you will be monitored using:

 

  • Laboratory tests – Blood samples are taken to assess for hormonal response of the ovaries during ovulation induction. The blood is drawn early in the day for estradiol levels at intervals scheduled by your fertility specialist.

 

  • Ultrasound scans – This noninvasive technique assesses the size and number of ovarian follicles. A vaginal probe is inserted to emit sound waves. The computerized device takes pictures for evaluation, and the images are recorded in real-time.

 

How is artificial insemination performed?

Artificial insemination involves placing sperm directly into the woman’s uterus. Studies show that artificial insemination can improve chance of pregnancy for couples with unexplained and male infertility, especially when combined with ovulation induction. Intrauterine insemination involves the use of a small catheter to insert sperm through the cervix and into the uterus. Around 14 million sperm are deposited using IUI.

After the male partner gives a semen sample, the specimen is prepared using specialized laboratory techniques to collect the most active and motile sperm. Preparing the sperm takes around 2 hours, but the actual insemination only takes a few minutes.

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