services

Ovulation Induction

Ovulation Induction
Occasionally women need to have their ovulation induced when they are having problems conceiving. Clomid is a fertility medication which induces ovulation. We usually start this medication at 50 mg. (one tablet) daily on days 3-7 of your menstrual cycle. If the lower dosing fails to induce ovulation we may increase the dosage. The ovulation may be accompanied by insemination or timed intercourse. When your period begins, mark this as "day 1" on your calendar and call the office to schedule an appointment to start the cycle.

Remember:

Clomid is a fertility medication. One important side effect is the possibility of multiple births. The probability of having twins while taking this medication is 7% (meaning 7 out of 100 women taking clomid will get pregnant with twins). It is rare to have more than twins (higher order multiples) with clomiphene citrate.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a relatively low tech approach to fertility treatment. It involves preparing the male partners sperm in the laboratory and then placing only those sperm which move well and are normally formed in the women's uterus. The sperm are transferred into the uterus at the time of ovulation. IUI can be performed with the sperm of the male partner or with donor sperm.

The success of IUI depends on 2 factors:
  • The indication for IUI (the reason it is being performed)
  • Whether performed in a drug stimulated or natural (drug free) cycle

Intrauterine insemination (IUI), obstetrics gynecology infertility, best fertility clinics
In general IUI is a good treatment if it is performed to overcome a problem of lack of sperm . It is also successful if intercourse is not occurring normally such as in cases of ejaculation dysfunction (ED). It is moderately successful when used for cervical mucus hostility when sperm are killed within the cervix. It tends to be less useful if the indication is male factor subfertility. The success rates are higher in a drug stimulated cycle (super-ovulation intrauterine insemination).

Intrauterine insemination is a successful treatment if used in appropriate couples. The chance of pregnancy is reduced in women over the age of 40 years and it is probably not an appropriate treatment for male factor subfertility if less than five million motile sperm are obtained at the end of the sperm preparation technique.

For most couples, up to three cycles of intrauterine insemination may be attempted assuming a good response is being maintained. After that time we would review treatment with you and either consider further IUI treatment or it may be appropriate to move onto other forms of fertility treatment at that stage.

What are the risks of intrauterine insemination treatment?

  1. Multiple pregnancy
    The most important risk of treatment with intrauterine insemination in a stimulated cycle is the risk of multiple pregnancy. Approximately 1 in 4 women who become pregnant following this treatment will have a multiple pregnancy. Usually this is a twin pregnancy, although triplet pregnancies are possible and occur in approximately 1 in 20 of all pregnancies conceived as a result of this technique. We will know how many eggs are being produced by the ultrasound monitoring discussed above, and therefore this should avoid situations which you may have read about where women have four or more babies as a result of fertility treatment. If, during your ultrasound monitoring, it is shown that you have many follicles developing, then it is preferable to cancel treatment in that month rather than risk several babies being produced! It is always preferable to err on the side of caution.
  2. Ovarian hyperstimulation (OHSS)
    The second risk of treatment is ovarian hyperstimulation syndrome. As the ovaries are stimulated more than they would be in a natural cycle, they become larger and contain fluid filled structures (follicles) that hold the eggs. Rarely the ovaries can become very swollen leading to a condition called 'ovarian hyperstimulation syndrome'.

    The symptoms of severe ovarian hyperstimulation syndrome include abdominal pain and swelling, shortness of breath, nausea, and possibly vomiting, and a reduction in urine output. In the presence of severe symptoms, hospitalisation may be necessary. This enables fluid, minerals and protein to be replaced and corrective measures taken to prevent further complications. The chances of OHSS developing are < 1 in 100 for patients having intrauterine insemination treatment. Although it is not possible to be certain which patients will develop ovarian hyperstimulation syndrome, those with the ovarian hormone abnormality called 'polycystic ovaries' are known to be more at risk. This condition will be assessed at the time of the preliminary consultation prior to starting treatment. However, this condition is very seldom.