Ovulation induction key concepts
- Ovulation induction refers to the use of medications to stimulate the ovaries to produce and release mature eggs, with the goal of increasing the chances of pregnancy.
- It’s commonly used for women who don’t ovulate regularly or have issues like polycystic ovary syndrome that can inhibit ovulation.
- It is prescribed as a standalone treatment or along with more advanced assisted reproductive technologies such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
- While generally well-tolerated, some patients may experience mild side effects such as hot flashes and mood swings; other risks are ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy (twins or more).
What is ovulation induction?
Ovulation induction refers to the use of specific fertility drugs to stimulate the ovaries. The goal is to promote the production and release of mature eggs, making them available for fertilization, either naturally or through fertility treatments. Ovulation induction is primarily employed in two scenarios: Firstly, for individuals who do not ovulate regularly or at all (known as anovulation), and secondly, to encourage the production of multiple eggs rather than the single egg typically released during a menstrual cycle.
Producing multiple eggs increases the chances for successful fertilization in treatments such as IVF and IUI. This approach is also routinely utilized for egg freezing and egg donation.
Related reading: Conceive Later by Freezing Eggs Now
About 25% of female infertility cases may be linked to issues with ovulation. Various factors, including polycystic ovary syndrome (PCOS), can contribute to these challenges and are often involved in unexplained infertility diagnoses. Typically, our physician starts with oral medications tailored to the individual’s needs, potentially moving to injectable medications if necessary.
Fertility drugs used for ovulation induction
There are several medications that can regulate or increase a woman’s chance of ovulation. We generally initiate treatment with the lowest effective dose of these medications, adjusting as needed.
This often means prescribing one of the following class of medications:
- Clomiphene citrate (Clomid), an oral medication prompting the pituitary gland to produce more follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which stimulate ovulation.
- Letrozole (Femara), an oral medication targeting lower estrogen production in the ovaries, similarly leading to increased FSH and LH levels.
- Gonadotropins (Follistim, Menopur and Gonal-F), injectable medications containing FSH, LH or both.
Diagnosing ovulation disorders and problems
Our fertility specialist Dr. Isaac Glatstein diagnoses ovulation disorders or problems through a combination of medical history, ultrasound examinations, lab work as well as specific tests to assess hormone levels and ovarian function.
When ovulation happens less than once every 35 days or is unpredictable, it is considered to be irregular. When ovulation is completely unpredictable – in interval or duration – it is considered oligo-ovulation. If it doesn’t occur at all, it is called anovulation. Ovulatory problems impact fertility by taking away the predictability of ovulation and potentially the availability of an egg to be fertilized.
We may conduct blood tests to evaluate hormone levels. Additionally, a transvaginal ultrasound can help assess follicle development and detect any patterns indicative of PCOS. This imaging can also confirm whether ovulation has occurred by observing changes in the uterine lining.
Conceiving Success
Ovulation induction FAQ
How long after ovulation induction will I ovulate? Ovulation usually occurs 5 to 10 days after starting ovulation induction medications, but the timing depends on your body’s response to the treatment. Regular monitoring through ultrasounds and blood tests will help predict when ovulation will happen.
Can ovulation induction cause twins or multiples? Yes, during natural intercourse and IUI, ovulation induction increases the chances of multiple pregnancies (twins, triplets, etc.) because it may stimulate the ovaries to release more than one egg. The likelihood varies depending on the medication used and fertility treatment plan. If used to stimulate egg production for IVF, we generally only implant one resulting embryo into the uterus for a single pregnancy, though twins are always possible.
Is ovulation induction painful? Ovulation induction itself is usually not painful, but some women may experience side effects like mild cramping, bloating, or discomfort from the medication or injections.
Can I do ovulation induction at home? While some parts of ovulation induction (like taking oral medications) can be done at home, the process usually requires regular monitoring by a fertility specialist to track your response and time ovulation accurately. Injectable medications also often require assistance from a healthcare provider or proper instruction for home use.
Benefits of ovulation induction
Ovulation induction can benefit a variety of individuals, including:
- Those experiencing irregular or absent ovulation limiting their chances of conception.
- Individuals undergoing IVF who require additional eggs to boost their chances of success.
- Patients with PCOS.
- Those diagnosed with unexplained infertility, meaning no specific cause can be identified.
- Individuals wishing to freeze their eggs for future use or those looking to donate their eggs.
Risks of ovulation induction
Fertility drugs may produce side effects of nausea, hot flashes, bloating, blurred vision, and headaches. In addition, inflammation can occur at injection sites.
Moreover, ovulation induction increases the risk of a multiple pregnancy (twins, triplets, etc.), which have known health risks for the mother and children. Induction also increases the risk of ovarian hyperstimulation syndrome (OHSS).
OHSS involves swelling of the ovaries that can be painful along with side effects of nausea, diarrhea and bloating. It occurs after ovulation induction and can be due to the drug dose being higher than the individual’s body can easily tolerate. OHSS most often happens with injectable medications but can also happen with oral medications. Most cases are mild, but more severe cases can bring rapid weight gain, exaggerated symptoms, shortness of breath, dizziness and dark urine. Women experiencing OHSS symptoms should discuss them with their physician.
In summary
Ovulation induction medications are among the most commonly used tools in the fertility toolbox. When monitored carefully by a trained physician, they are safe and often effective. There are some risks but are well tolerated by the majority of patients, who usually have excellent outcomes.