Ovulation induction - not all fertility treatment is IVF by Dr Aishwarya Parthasarathy, Fertility specialist, A4 Fertility Centre, chennai #ovulationinduction #FertilityTreamtent #a4fertilitycentre #a4hopsitals #chennai

1. Ovulation Induction
- Not all fertility
treatment is IVF
Dr. Aishwarya Parthasarathy,
Fertility Specialist, A4 Fertility centre.

2. Did you know?
●40% of all fertility related issues is because of
ovulation issues only?
●In clinical scenario most recently married women
coming to OPD for treatment with irregular cycles/
weight gain usually have ovulation as the only
issue

3. NOT ALL
TREATMENT
IS IVF

4. SIMPLE
TREATMENT
MOST
PATIENTS
REQUIRE
ONLY THIS

5. What is ovulation?
●Ovulation is the development and release of an ovum
(egg) from your ovaries
●Ovulation is the most fertile period of your menstrual
cycle.
● The function of the menstrual cycle is to mature and
release an egg and to prepare the uterus to receive and
nurture an embryo (a future baby).

7. Step 1
●During the first half of the menstrual
cycle, hormones from brain stimulate
growth and development of a single
follicle within one of the ovaries

8. Step 2
●When the egg matures, hormone levels surge and trigger the egg’s
release. The exact timing of ovulation relates to a woman’s
individual period
● In an average 28-day cycle, ovulation occurs between Days 13 and
15 – Day 1 being the first day of menstruation
●NOT EVERYONE OVULATES ON DAY 14
● The egg follicle releases a fertile egg, which migrates to the
uterine tube

9. Step 3
●As it makes its way from the uterine tube to the uterus,
the egg may be fertilised
●Only one sperm can penetrate the egg’s protective
membrane and fertilise the egg

10. Step 4
●As the first few cells divide, the embryo continues its
course toward the uterus
● On sixth day gets implanted into the uterus.

11. Step 5
●If for some reason, the embryo fails to implant, the
lining of the uterus is expelled, resulting in menstrual
bleeding (your ‘period’)

12. What is cycle day 1 ?
●Your menstrual cycle begins on the first day of your period and
continues up to the first day of your next period.
●If the flow occurs before 10 PM and at least one pad is soaked
consider it day 1

13. Fertile period
●You're most fertile at the time of ovulation (when an egg is
released from your ovaries), which usually occurs 12 to 14 days
before your next period starts
●This is the time of the month when you're most likely to get
pregnant
●Can be calculated only in regular cycles
●BROADLY 14 days minus the last day of the period

14. Fertile window
●It is the window when there is chances of maximum
conception
●It is ideal in a regular cycle only
●Several apps
●Any couple trying for pregnancy , can have sex between 11th
– 18th day atleast alternate days to maximize chances of
pregnancy

15. OTHER PRACTICAL METHODS
OF TRACKING OVULATION
●OVULATION KIT
●MEASURES LH –A hormone that aids ovulation
● Just like urine pregnancy test
●Place 2 drops of early morning urine over the kit
From Day 11 everyday
●Positive- Sex next 3 days
●Pitfall-May miss the LH; Can create anxiety

16. Ultrasound follicular monitoring
●Follicular tracking involves scanning the ovaries regularly
during the menstrual cycle and observing the follicles as they
increase in size
●Generally, these scans will start around day 10 of the cycle
and continue till day 15-18
●When the follicle is around 20 mm , planned sex is adviced

17. Causes of ovulation disturbances
●Polycystic ovary syndrome –Most common in south Indian
population
●Thyroid/ Prolactin disorders
●Stress
●Lifestyle factors (e.g. smoking, being overweight or
underweight)
●Unknown reasons

18. Evaluation
●When a couple comes for fertility treatment
●We ask a short history
●Check for hormones –Thyroid/Prolactin
●Check sperms
●Check egg numbers(By scan) and uterus
●Check tubes
●If the rest are normal and only egg releasing is the
trouble- Ovulation inducing drugs can be given

19. What is ovulation induction?
●What is ovulation induction?
● In simple terms it means producing an egg from an ovary that does not
release egg naturally. The purpose of ovulation induction is to develop a
single follicle to maturity and to ensure that it
●How is Ovulation induction done?
●It is done by the stimulation of egg development by the use of drugs
given either by tablet or injection.

20. What are the prerequisites?
1. At least one of the Fallopian tubes must be working, so the egg and
sperm can meet.
2. The sperm must be good enough to fertilize the egg (although the
sperm test cannot always predict that fertilisation will take place)
3. The ovary must be capable of producing an egg in response to the
stimulation provided
THIS IS DIFFERENT FROM IVF THAT Only 1 -2 follicles are
produced and not many like IVF

21. 1. If the periods come infrequently we induce a bleed by giving a 5 day course of
Progesterone (medroxy rogesterone 10 mg twice a day ), because to wait for a
period to come naturally might mean waiting a long time!
2. Drugs used to stimulate ovulation There are two main types of drugs used in
ovulation induction:
• Anti - Oestrogens (Clomifene 50-100 mg)- these are tablets given orally, which
increase the Pituitary production of Follicle Stimulating Hormone.
• Aromatase inhibitors( Letrozole 2.5- 5 mg)- They increase the release of
hormones from pitutatry and given especially in the cases of polycystic ovarian
disease
• Gonadotrophins - these are drugs which are always given by injection. The
active ingredient of this family of drugs is Follicle Stimulating Hormone that acts
directly on the ovary. Examples of such drugs are: Gonal F, Menopur, Menotas
HP.
• We might give these on day 6, 8 or depending on the requirement
Treatment process

22. How is the monitoring done?
● Vaginal scan is required
● If the lady is on the first cycle of ovulation induction, the consultant usually
monitors the follicles to assess the growth.
● The first scan is on the day 2/3 and following scans are on day 9/10, then day 12/13
depending on the growth.
● Gonadotrophins must be injected and are much more potent than oral medicines.
● As a consequence, patients commenced on injections are monitored more
intensively by scans and if necessary blood tests.
● If the lady produces a follicle and it has been tracked for one cycle, the future
cycles may or may not be monitored .
● You may request your consultant for a home based LH kit.

23. FAQ
Is it dangerous to get vaginal scans?
●Absolutely not
●Is it ok to get scanned when I’m bleeding on day 2/3-
Absolutely Ok. To check if the ovaries have no cysts , we
need to scan you in the early phase of the cycle

24. FAQ
My friend didn’t have injections. But you gave me
injections for follicle growth
●EVERY WOMAN AND EVERY OVARY IS DIFFERENT
●Some ovulate only on oral medicines
●Some require 1 or 2 injections
●Some require many more
●Be patient and clarify your doubts

25. FAQ
Will my eggs get depleted with medicines?
●There are nearly 2 lakh follicles which are there in a women’s
body at birth
●And every month thousands of follicles try to become a
dominant one
●Even if you don’t get treatment eggs will be depleted
●There is no scientific reasons for citing ovulation medications
as a cause of egg depletion

26. Success rates?
● Ovulation induction relies on natural conception after drugs have been given
to initiate the production and release of an egg.
● As a result the chances of a pregnancy, will be close to the rate of natural
conception in a woman who ovulates normally.
● This is about 20 % per cycle.
● You may require 3-6 cycles before moving forward to further treatment

27. What are the risks of ovulation induction?
●It is a very common treatment and fairly safe. Sometimes people
who are very sensitive might develop too many follicles , especially in
a gonadotropin based cycle and it may be a cause of concern.
Monitoring is important - this is particularly so with Gonadotrophin
therapy
●Multiple pregnancy (twins or triplet ) can occur
a) Clomifene therapy The risk of twins is approximately 10 % and
the risk of triplets is approximately 0.1 %.
b) Gonadotrophin therapy The risk of twins is approximately 20 %
and the risk of triplets is approximately 1 %

28. Follow us for more
updates:
/a4hospitals
https://a4hospital.com
Contact: 073050 58474