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Thursday, 18 June 2015

Ovulation Induction (OI)

Ovulation Induction (OI)

 One of the three common reasons why couples do not conceive is when the female partner is not ovulating. Although this can often be remedied using fertility tablets (clomiphene citrate), there are some women who need to use hormone injections and this is called "Ovulation Induction" (OI).

The hormone that stimulates production of eggs (oocytes) in the ovary is secreted from a small part of the brain (called pituitary gland) is Follicle Stimulating Hormone (FSH) It is FSH that is administered on a daily basis by using an injection pen into the fatty tissue in the abdominal wall when OI is used. The response to the hormone is the development of follicle or follicles in the ovary that contain the developing eggs. The progress of the developing follicles is monitored by measuring the oestrogen hormone they produce by blood tests, and by watching them grow on ultrasound examination. The dose of the FSH is then adjusted with a small increase every seven to ten days, in line with the response. 

The aim is to stimulate preferably one or two and a maximum of three ripe follicles. When the size of the follicle and the oestrogen level suggests that the follicle is ripe, another hormone, Human Chorionic Gonadotrophin (HCG) is administered which releases the egg. All the couple have to do usually is to have intercourse around the time of ovulation.

We usually obtain about 20% pregnancy rate per cycle, with a small risk of multiple pregnancy (usually only twins) of about 20%.
The risks are that too many follicles may be produced, and then the cycle is cancelled (the HCG hormone is not administered) and intercourse is avoided. It is very rare for the symptoms of sore swollen ovaries with abdominal fluid (ascites) to develop after OI.

After the first cycle if there was ovulation but no conception, the cycle is repeated. If too many follicles were produced, the dose of FSH is kept lower for longer.

Over 80% of women who undergo OI have a successful pregnancy within six cycles. Occasionally there are other fertility abnormalities that require progressing to IVF.


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