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Ovulation induction is used as the first line of treatment to treat anovulatory related infertility provided that at least one of the fallopian tube is open. 

Ovulation induction is the use of medications (tablets or injection) to trigger ovulation. In 20% of infertile couples, the cause of infertility is anovulation, and the commonest cause of anovulation or absence of ovulation is polycystic ovarian syndrome (PCOS).

After the fertility investigations, the patients whose cause of infertility is anovulation, the first line of treatment used in our clinic is ovulation induction with clomiphene citrate or letrozole. The oral medication clomiphene citrate is an anti-oestrogen that acts by increasing follicle stimulating hormone (FSH) production release from the anterior pituitary. This stimulates follicular development. The clomiphene (clomid) is taken for five (5) days, starting from day 2 to 6 of the cycle, usually with 50mg daily.

At JAFC, a transvaginal ultrasound scan is done before commencing clomid, to rule out ovarian cyst. Follicular tracking is done on day 10 and 12, using the transvaginal scan to determine when the dominant follicle reaches the right size >17mm and to make sure that no more than 1 or 2 follicles made it to that size.

Alternatively, the injection of gonadotropin can be used when the oral medication (Clomiphene citrate) is not giving the desired response. It is usually low dose, 75IU daily or on alternate days is given starting from day 2 or day until the dominant follicle is at least 17mm. The aim of ovulation induction is to get the ovary to produce 1-2 eggs at a time.

Once this size is achieved and the number of follicles confirmed, HCG injection (5,000-10,000IU) is given to trigger final maturation and release of the egg. Timed intercourse 36-40hrs thereafter is advised.

  1. Who qualifies for this treatment?

To qualify for ovulation induction, at least one of the fallopian tubes must be patent and functional, and the sperm parameters should be normal.

  • The treatment for one cycle usually takes about three weeks, from day two of cycle to day 21 when progesterone test is done to suggest ovulation. Within this period, at least four visits are made to the gynaecologic clinic.
  1. What is the Success rate?

The success rate is divided into successful ovulation and then pregnancy. Achieving ovulation after this treatment is about 40%, and achieving pregnancy is 10-20% in one cycle of treatment.

  1. How long do I keep trying ovulation induction?

It is expected that after 3-6 months of ovulation induction with oral medication or injection, and no pregnancy, the next line of action which is IUI or IVF should be taken.

  1. What are the complications of ovulation induction? 

Complications associated with ovulation induction include:

  • Vaginal dryness when clomiphene citrate is used for the induction
  • Development of ovarian cyst 
  • A slight increase in multiple birth rate
  1. What are the steps involved in Ovulation induction?
  • First Consultation and evaluation
  • Comprehensive fertility investigation
  • Review of fertility investigation results and discussing treatment plan
  • Day 2 of cycle for transvaginal scan and commencing ovulation induction
  • Follicular tracking using the transvaginal scan on days 10, 12 or more until dominant follicle is at least 17mm
  • HCG injection to trigger ovulation
  • Timed intercourse 36-40 hours after HCG administration
  • Day 21 progesterone test
  • Pregnancy Test

What is the cost of treatment?

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