 Ovulation
induction is a term that refers to the administration of medication
to stimulate ovulation. These medications range from letrozole
to gonadotropins and ccombinations of the two. Gonadotropins are
injectable ovulation stimulating hormones that are identical to
the hormones secreted by the body. With the administration of
these injectable medications, we are able to increase the circulating
levels of these hormones, resulting in the stimulation and growth
of multiple eggs. In addition to increasing the number of eggs
with the use of gonadotropins, we control timing factors, such
as when ovulation occurs, to maximize the chance of becoming pregnant.
A variety of medications are utilized for ovulation induction.
The simplest is letrozole, which can be taken orally. Letrozole
is typically used alone or in conjunction with injectable gonadotropins
to help stimulate the ovaries.
There are multiple types of gonadotropins available for ovulation
induction. These products include Follistim, Gonal- F, Bravelle,
and Repronex. The most commonly used gonadotropin for ovulation
induction at Southeastern Fertility Center is human menopausal
gonadotropin (hMG) which contains both Follicle Stimulating Hormone
(FSH) and Luteinizing Hormone (LH).
We closely monitor all cycles involving gonadotropins. We can monitor a patient's response in two ways:
- Estradiol Levels - Estradiol is released into the blood by the growing follicles as they respond to medications. Tracking this rise in estradiol levels can help us follow egg development.
- Vaginal ultrasounds - Vaginal ultrasounds
can visualize the number of developing eggs and measure their
size and growth. The picture on the upper left shows multiple
eggs developing on the ovary and the picture on the bottom right
shows good endometrial development (the inside of the uterus).
Early in the stimulation cycle we measure estradiol levels and
perform vaginal ultrasounds every couple of days to assess growth.
Towards the end of the cycle we perform these assessments more
frequently to control the timing factors that will maximize the
chances of becoming pregnant and minimize side effects.
Ovulation induction cycles are usually followed by the administration
of human chorionic gonadotropin (hCG), an injection to induce
ovulation. Intrauterine inseminations are performed 30 to 40 hours
after the hCG injection which is just prior to ovulation. Intrauterine
inseminations use specially prepared and concentrated sperm, which
helps to maximize the number of sperm available for fertilization.
 There are side effects and risks associated with gonadotropin use. The most common side effects of these medications include discomfort or "fullness" in the lower abdomen, bloating, headache or fatigue. Patients can also experience discomfort in the area of injection. Massaging the area or applying heat is often helpful.
Perhaps the most significant risks of using injectable gonadotropins are multiple gestation and ovarian hyperstimulation. Ovulation induction can have up to a 20% incidence of multiple gestation (more than one fetus). The majority of these pregnancies are twins, however, more than two fetuses can sometimes develop. Vaginal ultrasounds help us to determine how many follicles you have developing, but this is only a guide and not a specific count. If you should develop too many follicles, you may be counseled to stop treatment to avoid the risk of multiple pregnancies. Pregnancy with three or more fetuses at a time places both the mother and fetus at high risk for miscarriage, pre-term delivery and bleeding. At Southeastern Fertility Center we take this risk very seriously and will monitor your progress very closely to help minimize the chances of a multiple pregnancy.
Ovarian hyperstimulation is also a possible side effect of ovulation induction and typically occurs 5-7 days after hCG injection. After hCG is given and ovulation occurs, the ovaries will frequently enlarge. If pregnancy results, the ovarian enlargement may persist for up to six weeks. In general, the symptoms associated with ovarian hyperstimulation are mild and may include lower abdominal pain, heaviness and bloating. Sometimes shortness of breath may also develop. It is extremely uncommon for hyperstimulation to result in any severe medical problems or hospitalizations. We will closely follow your progress to avoid problems of ovarian hyperstimulation.
Ovulation Induction/IUI Success Rates
"Success" can have various meanings in the world of medicine. Accordingly,
when evaluating pregnancy rates it is important to understand the rates being
quoted. It is clear that the best measure of success for any infertility treatment
is the "take home baby" or "live birth" rate per cycle of
infertility treatment. Given the time period being quoted the "live birth" rate
may not be available and in that situation the best measure of success is the
clinical pregnancy rate defined as the percent of IVF cycles resulting in a pregnancy
with fetal cardiac activity within the uterus at 7 weeks of
pregnancy.
2007 Pregnancy Rates Per Cycle
The clinical pregnancy rates per cycle for the year 2007 from 510 consecutive
ovulation induction and intrauterine insemination cycles broken down by patient
age are displayed below. Please note that the number of patients in the 40
years of age and older group is small and therefore the pregnancy rate may
not be accurate for a larger group of patients.
* Clinical pregnancy is defined as a pregnancy with fetal cardiac
activity within the uterus at 7 weeks of pregnancy (5 weeks after egg retrieval).
** A comparison of clinic success rates may not be meaningful because patient
medical characteristics and treatment approaches may vary from clinic to clinic.
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