Ovulation Induction & Tracking

About Ovulation Induction

Ovulation is the process by which a mature egg is produced and released from the ovary to be fertilised by a sperm. In response, the uterus (womb) lining thickens and prepares for the implantation of the fertilised egg. Hormones control ovulation. However, low hormonal levels may lead to problems with conception. Ovulation induction is hormone therapy that stimulates your ovaries to release eggs.

Indications for Ovulation Induction

Ovulation induction stimulates egg development and releases in women who cannot ovulate. The goal is to produce multiple eggs in a single cycle to increase the chance of conception. It is usually ordered with other assisted reproductive techniques like intrauterine inseminations (IUI, injecting high-quality sperm directly into the womb for fertilisation).

Preparing for Ovulation Induction

Before ovulation induction, your ovulation cycle is confirmed by measuring your blood hormone levels. A vaginal ultrasound scan (imaging technique using sound waves) is performed to view the development of follicles in the ovary and the appearance and thickness of the womb's lining.

During Ovulation Induction

Initially, ovulation induction involves taking tablets [either letrozole or clomid] from D2-D6 of your menstrual cycle. If you don’t have spontaneous menstrual cycles, this will be brought on by a 5-day course of progesterone tablets. A TVS is done on approximately D12 to assess the growth of the follicle/s. If not yet mature, this may be repeated a few days later. 

Once a mature follicle is present, ovulation is induced with an injection called ovidrel. If planning on natural conception, intercourse is recommended over the next 48 hours, or if doing IUI, it will be performed the day after the injection.

If the ovaries do not respond to the maximum dose of these tablets, then on subsequent cycles, FSH injections are given from D2 of the menstrual cycle, and monitoring is done by TVS every 4-5 days until a mature follicle develops, then ovulation is induced with ovidrel.

Risks & Complications with Ovulation Induction

The most common complications associated with ovulation induction are the development of ovarian cysts and multiple births. The procedure may sometimes lead to the overstimulation of the ovaries (ovarian hyperstimulation syndrome), which may cause severe pain in the chest, abdomen and pelvis, weight gain, nausea and difficulty breathing.

Ovulation induction controls the time of egg release so you can accurately schedule sexual intercourse and other assisted procedures such as IUI and IVF (fusion of egg and sperm in the lab) to increase your chances of pregnancy.

About Ovulation Tracking

Ovulation tracking involves conducting vaginal scans [and occasionally blood tests]at specified times during the menstrual cycle to pinpoint the time of ovulation, so you know the best time to have intercourse to facilitate pregnancy.

The hormones that we may monitor include:

• Follicle-stimulating hormone (FSH) – Follicles are small fluid-filled cysts on the ovaries containing an egg. FSH is the hormone responsible for stimulating follicular growth so that one follicle grows to approximately 2cm in diameter in the middle of the month, ready for ovulation.
• Luteinizing hormone (LH) – There is a sudden surge of LH in the middle of the menstrual cycle (around day 14 in a 28-day cycle). The surge of LH causes the egg inside the large follicle on the ovary to mature and triggers ovulation approximately 36 hours after the surge's peak.
• Oestrogen – oestrogen is released by the ovaries. As a follicle develops, oestrogen levels in the blood increase. Monitoring your oestrogen levels indicates the growth of follicles in the ovaries, allowing us to predict when the LH surge and ovulation are likely to occur.
• Progesterone – Progesterone levels remain low throughout the initial stages of the menstrual cycle, rising only after ovulation. We can confirm that ovulation has occurred by taking a progesterone level a week after the LH surge.

Sperm will stay alive inside the female pelvis for 2-3 days after intercourse. Eggs will only survive for 12-24 hours after ovulation. Therefore, it is ideal if you have intercourse immediately before ovulation. By detecting the LH surge, we know that ovulation is about to occur, therefore, we can advise you to have intercourse within the next 24 hours to optimise your chance of conception.

Ovulation tracking can also identify ovulation issues that require further investigation and treatment to facilitate pregnancy.

If you do not conceive after six cycles of ovulation tracking, in which ovulation has been demonstrated, Dr Turner will discuss with you other treatment options.