Ovulation is the release of an egg from a woman’s ovaries and is essential for conception. Ovulation naturally occurs about 36-40 hours after blood levels of a hormone called luteinizing hormone (LH) rise. This is called the LH surge/peak. Once released from the ovary, the egg is picked up by the fimbriae and travels down the fallopian tube where it can meet sperm to become fertilized.
A problem with ovulation (or anovulation) is a common cause for infertility. For couples trying to fall pregnant, knowing when the woman is about to ovulate can be particularly helpful in planning when to have sex. If a woman is trying to find the reason she is not falling pregnant, it is helpful to know if she is ovulating. Having regular menstrual periods between 25 and 35 days in length accompanied by menstrual cramps is a good indication of ovulation.
If it becomes clear that a woman is not ovulating, or has irregular cycles, Ovulation Induction with paired with Timed Intercourse is often the first step in the infertility treatment journey.
How to start with Ovulation Induction Treatment
If ovulation induction is considered, the first step is to make an appointment with a fertility specialist to have a comprehensive discussion about possible causes of the infertility experienced. A sperm test result should be available to confirm that induction and timed intercourse is an optimal option when discussed with the doctor.
It is highly recommended that both partners to be at this consultation since all aspects of the fertility treatment are discussed and questions can be answered. Blood tests may be done and prescriptions for medication may be given. The fertility sister and laboratory staff may also talk to you about the process.
A sperm test should be done at the unit, especially if a previous test is older than 1 year or if it has been done at a different lab that is not an accredited South African fertility unit, since sperm production may change over time and good fertile sperm population is necessary for the process to be optimal.
Before the treatment starts, the nursing sister or accounts department is to be contacted about the costs and procedures involved and help answer any questions you may have.
The Ovulation Induction Treatment Cycle
The first month needs to be a monitored cycle, this means that you will come in for several scans and then do several blood tests in this month. The patient should contact the fertility sister as soon as her menstruation starts. Should this fall on a weekend, she can contact the sister early on Monday morning. The first day of menstruation will be referred to as Day 1 and the stimulation medication is started usually on Day 3 or 4 of the cycle. The sister will then assist her to make an appointment for the first sonar scan with the doctor and discuss the treatment plan and stimulation medication again. In some cases blood tests and/sonar scan may be needed before medication is started and thus it is important to contact the sister at the start of her cycle. Kindly note that we consider Day 1 to be the first day of the bright red blood flow as the start of your menstruation.
There are several different medications with different strengths and actions. They will be prescribed according to the individual diagnosis and response of the ovaries and eggs. The medication are in the form of tablets, e.g. Clomid, Fertomid, Femara, Laradex and injections, e.g. Menopur, Gonal-F. These medications include some that contain FSH (follicle stimulation hormone) to stimulate the eggs to grow. The stimulation medication will usually be taken initially from Day 4 to 8, to start the egg growth.
You will have a scan on Day 3 or 4 of your menstrual cycle to check that there are no cysts or polyps and to make sure that the lining of your uterus (endometrium) is regular and thin. Dr will also count to see how many follicles there are that might respond to the medication.
The sonar scan on Day 10 or 11 enables the doctor to monitor how the follicles (containing the eggs) are growing and also the development of your endometrial lining. One or several scans may follow to monitor the growth of the follicles and some blood tests will be done.
When the leading follicle is around 18mm, we will commence blood LH testing. A rise in LH levels in the blood can predict when the follicle (sac where the egg ripens) is ripe and ready for ovulation. Because LH is released in pulses or short bursts, the LH surge is not always found by a single blood test. Therefore, it may be necessary to perform 2 or more of these tests on consecutive days.
Although determining if, and when ovulation is occurring might seem frustrating and time consuming, it is often an essential step toward achieving pregnancy.
A home pregnancy test is less accurate, but can be done if your menstruation is a few days late. The urine test result should be confirmed with a blood test. You can call the nursing sister any time should you have questions about the testing or interpretation of the results.
Should the medication and or dose require any adjustments in the following month, you may be required to come in for scans again in that month.
Once we have identified your specific treatment plan, in terms of the correct type of medication and dose, as well as your LH peak, you will then be given your ‘fertile days’ and timed intercourse can then happen accordingly for the next 4 – 6 months.
Patients above the age of 38 years or couples with a known male factor will be given 3 months and then a planning session will be held with your treating doctor to discuss the next step.