Considering Ovulation Induction?

If your periods are irregular, you have PCOS or you're struggling with unexplained infertility, you may have been recommended Ovulation Induction (OI) as a first line fertility treatment. But what is it, is this right for me, and what exactly do I need to know here?

What is OI?

OI involves the use of hormonal medications taken at the beginning of your menstrual cycle, together with individualised treatment plans to help stimulate ovulation. The body's response is then monitored with ultrasounds and blood tests.

OI involves the use of hormonal medications taken at the beginning of your menstrual cycle… to help stimulate ovulation.

For many, OI together with sexual intercourse at just the right time (TSI) to coincide with ovulation may be all that's needed. Your fertility specialist will establish when you are due to ovulate, and will recommend a specific timeframe to have sex with your partner.

Who is OI for (and not for)?

OI is primarily advised for women with:

• Unexplained infertility
• Irregular ovulation cycles
• Long, irregular or infrequent cycles
• Pre-existing conditions such as PCOS

It's less likely to be recommended if:

• You have tubal blockage or damage
• You have severe endometriosis
• Male infertility factor exists in the equation
• You're over 38 years of age

What's the OI process?

Step 1: Initial consultations

Once starting with a fertility specialist, you will have a series of tests prescribed to formulate a diagnosis and set up your fertility treatment plan.

Step 2: Start medication

Treatment starts at the beginning of your menstrual cycle. Fertility stimulants are prescribed here to encourage the growth of follicles that contain eggs. You can expect to be prescribed one of the following medications:

• Clomiphene (Clomid) tablets which trick the pituitary gland into producing more follicle stimulating hormone to help follicles develop. They are usually taken from day 2 to day 6 of the menstrual cycle.
• Injectable gonadotropins are used once the follicles are mature, to start ovulation.
• Follicle Stimulating Hormone (FSH) daily injections, used to stimulate the ovary to produce egg-containing follicles and encourage those follicles to mature.

Step 3: Monitoring

If you're taking an oral treatment, ultrasound testing may not be necessary here, but for most, this step involves monitoring with ultrasounds and blood tests.

Step 4: Trigger injection

Some women here will be given a 'trigger injection' (an injection of Human Chorionic Gonadotropin or hCG) to assist with the final maturation of the egg and loosening of the egg from the follicle wall. Whether you'll need a trigger injection, and the timing of it, all depends on your individual situation (i.e. size and amount of follicles).

Step 5: Timed sexual intercourse (TSI) or intrauterine insemination (IUI)

Depending on your situation, you will start TSI. A combination of OI and IUI may be recommended in some cases. This involves inserting your partner or donor's cleaned up semen sample directly into the uterus to coincide with ovulation.

Step 6: Results

Instead of relying on regular pregnancy tests, your fertility clinic will recommend attending a collection or pathology centre for a blood test. These are performed at a specific time defined by the clinic, typically 16 days after you ovulate.

What can I expect to feel?

Due to the additional hormonal medications given during this treatment, many women experience physical symptoms. Common side effects of OI include:

• Abdominal distension and bloating
• Mood swings
• Fatigue

For some, fertility medication can lead to Ovarian Hyperstimulation Syndrome (OHSS). If this occurs, you may notice nausea, vomiting, shortness of breath, excessive weight gain, and dehydration. This condition may improve on its own, or require additional treatments. Contact your fertility clinic for further advice if you feel this is affecting you.