Ovulation Induction- Fertility/Reproductive Medicine and IVF, Obstetrics and Gynecology
Ovulation induction (OI) uses hormonal drugs to stimulate the production and release of an egg from the ovary.
Ovulation is the process of release of an egg from the ovary. It is a part of a normal menstrual cycle. If sperm fertilizes the egg, it travels to the uterus and pregnancy may occur. If fertilization does not occur, the egg is released from the body during the menstrual cycle.
A woman may become unable to ovulate on her own due to a variety of factors. These include stress, changes in weight, and a condition called Polycystic Ovary Syndrome (PCOS).
Other causes may include:
- Increased levels of prolactin hormone
- Failure of the pituitary gland to produce sufficient Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH)
Ovulation induction is suitable for women who have problems with the pituitary gland.
Before your doctor starts treating ovulation problems with drugs, they may ask you to undergo certain tests. These include:
A pelvic ultrasound
Synonyms: Pelvic Ultrasonography, Pelvic Scan, Gynecologic Ultrasound, Transabdominal Ultrasound
This is a noninvasive diagnostic exam. It produces images of the organs and structures in the pelvic region, such as the uterus, fallopian tubes, ovaries, cervix, and vagina.
The ultrasound device sends high-frequency sound waves to the internal organs in the pelvis. Once the waves bounce back from the organs, it processes them and creates the images. The images help your doctor detect abnormalities in the organs.
Blood tests
These tests measure the blood levels of hormones such as thyroid, prolactin, FSH, LH, testosterone and other male hormones. Besides, you may need to check the blood levels of progesterone.
Low levels of progesterone, FSH, and LH usually indicate a problem with ovulation.
Physical examination
Women who have high levels of male hormones in their bloodstream will likely have excessive hair on the face and body.
Moreover, daily body temperature measurement can give you an idea of ovulation. The level of progesterone rises gradually during ovulation. It causes elevated body temperature. On the other hand, a constant body temperature indicates a problem with ovulation.
Drug Therapies to induce ovulation
Once your doctor confirms the problem with ovulation, they may ask you to take certain drugs. These include:
Clomiphene citrate tablet
Clomiphene citrate stimulates the pituitary gland to produce FSH. FSH is key to stimulating egg production by the ovary. It significantly increases ovulation rate and pregnancy rate.
Alternately, your doctor may prescribe Tamoxifen or Letrozole. Like clomiphene, tamoxifen is an “anti-estrogen”. Tamoxifen may work in women who cannot ovulate with clomiphene.
Letrozole blocks the activity of aromatase, an enzyme that increases the production of estrogens. Increased estrogen can prevent ovulation by reducing FSH production.
Gonadotropins injections
Women who fail to ovulate with oral drugs may benefit with gonadotropins. They contain either FSH or a combination of FSH and LH. A healthcare professional injects these drugs daily under the skin.
The doctor monitors the success of drug therapy by examining ultrasound scans. Depending on your response, the therapy may continue for six continuous cycles.
Ovulation induction drugs may induce multiple pregnancies in some cases. Talk to your doctor about the risks of the drugs.
Sources:
- https://www.sciencedirect.com/topics/medicine-and-dentistry/ovulation-induction
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808395/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205537/
- https://www.ncbi.nlm.nih.gov/pubmed/30470497
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