Ovulation Induction in India
Ovulation Induction is a simple process which encourages your ovaries to release eggs, so you maximise your chance of conception through intercourse or artificial insemination (IUI). It suits women who are producing low levels of hormones for ovulation, or who are not ovulating at all. You’ll take medication (as tablets or through injections) to stimulate your hormones.
How does Ovulation Induction work?
First, your ovulation cycle will be confirmed by:
- Taking blood samples to measure hormone levels at specific stages of your cycle,
- Carrying out a transvaginal ultrasound to see the development of follicles in the ovaries, and the thickness and appearance of the lining of the womb.
The Ovulation Induction cycle
Day 1: (of your menstrual cycle) Call the clinic to arrange an appointment for a blood test.
Day 4: Start taking medication.
Day 10 or 11: Visit the clinic for a blood test to determine your hormone level.
Day 14: (approximate) Attend the clinic for an ultrasound test. This will determine if you are about to ovulate.
For women who don’t have a normal menstrual cycle, it may take some time to ovulate. In fact, it is not unusual for ovulation to occur much later in their cycle (after Day 14). You would then need to continue attending the clinic for blood tests until this point.
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Ovulation induction medications, often referred to as fertility drugs, are used to stimulate the follicles in your ovaries resulting in the production of multiple eggs in one cycle. The medications also control the time that you release the eggs, or ovulate, so sexual intercourse, intrauterine inseminations, and in vitro fertilization procedures can be scheduled at the most likely time to achieve pregnancy.
There are risks associated with the use of ovulation induction medications including an increase in the chance for high order multiple births and the development of ovarian cysts. A rare side effect that can occur is ovarian hyperstimulation syndrome (OHSS); symptoms include severe pain in the pelvis, abdomen and chest, nausea, vomiting, bloating, weight gain and difficulty breathing.
The medications most commonly used in fertility treatment are clomiphene citrate, gonadotropins, Metformin and Parlodel.
Clomiphene Citrate (Clomid, Serophone) – This medication comes in a tablet form and is used for women who have infrequent periods or long menstrual cycles. Common side effects include headaches, blurred vision and hot flashes.
Gonadotropins (Repronex, Follistim, Bravelle, Pergonal and GonalF)- This is an injectable medication that is used to induce the release of the egg once the follicles are developed and the eggs are mature. Side effects may include abdominal distention/discomfort, bloating sensation, mood swings, fatigue or restlessness. In most cases, the side effects are relieved by follicular aspiration.
Glucophage (Metformin) -Metformin is given to patients as an insulin lowering medication. Most commonly used in PCOS patients, the medication has been shown to reverse the endocrine abnormalities seen with polycystic ovary syndrome within two or three months. The use of Metformin can result in decreased hair loss, diminished facial and body hair growth, normalization of elevated blood pressure, regulation of menses, weight loss and normal fertility.
Parlodel – Parlodel is a medication used to lower prolactin levels. It will also reduce pituitary tumor size, should one be present. An oral medication taken with meals, Parlodel has few side effects and is relatively inexpensive.
There are different levels of ovulation induction commonly used to treat infertility related to ovulation disorders, male factor or unknown causes. One method of treatment involves clomiphene citrate (Clomid or Serophene) taken in pill form for 5 days at the beginning of a cycle. For women whose only infertility problem is anovulation, up to 80% of patients will ovulate using this medication and 50% of those will conceive . Clomiphene may be combined with intrauterine insemination to boost the success of the medication by placing the sperm and egg in closer proximity to each other.
The more aggressive level of ovulation induction is called superovulation. This treatment uses gonadotropins or sometimes a combination of clomiphene and gonadotropins to stimulate the production of multiple eggs. Patients undergoing superovulation must be closely monitored by blood tests and ultrasounds. Monitoring ensures that the patient does not hyperstimulate and also helps the physician administer the correct dosage of medication so that only a few follicles develop. This is a critical step to keeping the multiple pregnancy rates low. At the end of the superovulation treatment process, a low dose HCG (human chorionic gonadotropin) may be prescribed to stimulate ovulation. Ovulation will occur between 24-36 hours after HCG. The patient is instructed to either have intercourse during this time or to come in for an intrauterine insemination. Depending on the cause of infertility, the success rate per superovulation treatment cycle is approximately 10-20% based on the woman’s age.
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