ovulation induction

The goal of this treatment is to stimulate or induce ovulation (egg release) through drug therapy. The drugs used can be administered in the form of tablets, injections or a pump. This depends on a range of factors including the underlying reason for the ovulation problem.

Your doctor will consider the best approach for you individually. In most cases, tablets – clomiphene citrate - are the first-line option. During treatment, the reaction of the ovaries is monitored at the clinic. If ovulation has not been induced one month, then the dosage may be increased for the next cycle.

If clomiphene citrate fails, an ovulation is still not induced at the maximum dosage (“clomiphene resistant”), then various other treatments can be used.  In women with polycystic ovaries, another medicine (metformin) may be added to clomiphene or surgical intervention proposed.

The next step is usually the injection of follicle stimulating drugs containing gonadotropins. Sometimes injections are used straight away. Here too, the necessary dosage for each individual will have to be determined. The age of the woman and her ovary ‘reserve’ play a role in the chances of success: in general, at a later age a slightly higher dosage is necessary to induce an ovulation.

Pumps are used to administer the hormone gonadatrophin releasing hormone (GnRH) usually in cases where the women has
hypothalamic amenorrhoea disorder –the lack of menstruation/ovulation as a consequence of reduced GnRH production.

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ovarian hyperstimulation

Aside from prescribing these medicines in order to induce an ovulation, these medicines are also often used by women who are receiving fertility treatments for other reasons. Their use in combination with other fertility stimulating techniques, such as intrauterine insemination (IUI) or in vitro-fertilisation (IVF), is however substantially different from their use in ovulation induction. Instead of one ovum (egg), the goal is now to stimulate multiple ova to mature.  A distinction is made between mild ovarian hyperstimulation for IUI in which the aim is to obtain just a few follicles and controlled ovarian hyperstimulation for IVF procedures.

In order to follow the growth of the follicles and because therapies can sometimes have side effects, you will undergo regular check-ups at the clinic. It is not only important to monitor whether an ovulation occurs, but also to prevent a situation where too many eggs mature at the same time. For instance in the case of IUI this may mean there is an unacceptable risk of a multiple pregnancy. The maximum acceptable number of eggs depends on the type of treatment. The occurrence of ovulation can be monitored in various ways. Your doctor will discuss the options with you.

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general risks

Aside from the fact that the drugs themselves may have side effects, there may also be risks connected with treatment. For example, one general risk of treatments in which ovarian hyperstimulation is employed is the occurrence of over-stimulation. The chance of this occurring is greater during controlled ovarian hyperstimulation (IVF/ICSI) than during mild ovarian hyperstimulation (IUI); and higher with gonadotropins than with clomiphene, but the principle remains the same.

Additionally, ovarian hyperstimulation increases the risk of multiple pregnancy. This chance also varies for each type of treatment and can be partially overcome through control and, in IVF, replacing fewer embryos.

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