Ovaluation induction

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Approximately 25% of infertile women have problems with ovulation – the process when a mature egg is released from the ovary. The inability to produce and/or release eggs is called anovulation.

Ovulation induction involves the use of medication to stimulate development of one or more mature follicles in the ovaries of women who have anovulation and infertility.

Which medicines are used for inducing ovulation?

  1. Clomiphene citrate - the most commonly prescribed ovulation drug. Clomiphene works by causing the pituitary gland to secrete more FSH. Higher level of FSH stimulates the development of ovarian follicles. The standard dosage is 50-100 mg per day for 5 days, starting from the second day of the cycle.
  2. Aromatase Inhibitor (Letrozole) – is used as a second line therapy, when Clomiphen citrate does not work. Enzyme aromatase is inhibited by the letrozole medication, which leads to suppression of oestrogen. This results in the brain and pituitary gland starting to increase the production of FSH (follicle stimulating hormone). Higher level of FSH stimulates the development of ovarian follicles. The tablets are taken at the beginning of the cycle starting on Day 2, for a period of 5 days.
  3. Gonadotrophins ( FSH containing medications) – this is an injectable medicine of FSH, which stimulates the development of ovarian follicles. The dosage is prescribed strictly by the doctor. The injections start early from the second day of the cycle and continue for approximately 10-12 days.

Patients undergoing ovulation induction must be closely monitored by blood tests and ultrasound scanning. Ultrasound monitoring allows us to determine appropriate date to have sexual intercourse to maximise  the chances of fertilization. When the follicle is above 18 mm HCG injection can be prescribed, that helps with the final maturation of the eggs and triggers the ovaries to release the mature eggs (ovulation). It also stimulates the corpus luteum to secrete progesterone to prepare the lining of the uterus for implantation of the fertilized egg. Ovulation (follicle rupture) usually occurs about 36 hours after the hCG is given. The treatment usually continues for 6 cycles.

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