Infertility is more common today than many realise, often influenced by factors like lifestyle and dietary habits. As a result, the journey to conception can be challenging for many couples, causing significant emotional and physical strain. However, despite these difficulties, there is no need to fear as support and solutions are available.
A few lifestyle changes and advanced medical treatments have made assisted reproductive technologies available. Ovulation induction is one such procedure where the ovaries are stimulated to produce multiple mature eggs. This improves the probability of pregnancy rates.Ovulation Induction: An Overview
Ovulation is an important stage in the menstrual cycle for conception. During this time, an egg is released, increasing the chances of pregnancy. However, various factors can make it harder for some women to conceive. Ovulation is mainly controlled by two hormones: follicle-stimulating hormone (FSH) and luteinising hormone (LH), which work together to trigger the release of the egg.As natural ovulation only allows one egg to be released, a fertility treatment called ovulation induction can stimulate the ovaries to release multiple eggs. This procedure is mainly used with IUI and IVF to increase conception rates. Certain hormonal medications are given to the patient during this time to carry out this procedure.Mechanism of Ovulation Induction
Ovulation induction stimulates the hormones that are responsible for ovulation. During ovulation, your body releases a single egg, but this can be changed with the help of some hormonal medications. Ovulation induction uses specific medicines such as clomiphene citrate, gonadotropins or letrozole to stimulate the ovary to release multiple eggs.Before you can start this procedure, doctors will require you to undergo a clinical assessment to test various factors in your body, such as your reproductive health, hormonal levels, and egg counts.Ovarian stimulation can be done through oral medications or injections, which promote the growth and development of eggs within the follicles. The dosage of these medications is volatile, and the doctor adjusts them according to the daily blood test and ultrasound scan reports. Once there are enough eggs within the ovary, ovulation is triggered.IVF and IUI with ovulation induction
Assisted reproductive technologies (ART) such as IVF or IUI are carried out with the help of ovulation induction. These methods utilise the principles of ovulation induction in the following ways: - Ovulation Induction with IUI: IUI works particularly well with ovulation induction. IUI improves the conception rate by inseminating concentrated sperm directly into the uterus. When paired with multiple egg releases from ovulation induction, the chances of pregnancy improve significantly.
- Ovulation Induction with IVF: IVF and Ovulation induction work well in pairs. IVF is usually carried out by producing multiple embryos. So, when this process is paired with ovulation induction, it makes it easier for doctors to get multiple eggs to create viable embryos.
The greater the number of embryos, the better the probability of a successful pregnancy. Doctors also get a plethora of embryos to analyse and choose the most promising one among them. - Medicines used during ovulation induction
Ovulation induction is performed with the help of various hormonal medications. Some of the most prescribed medicines during this process are: - Clomiphene Citrate: This medication is consumed orally and supports the production of FSH and LH. These hormones work in harmony to regulate ovulation in women and are also responsible for the development of the eggs inside the ovarian follicles.
- Gonadotropins: The base hormones present in this medication (injection) are FSH and LH, which are the pillars for inducing ovulation in women naturally. This promotes the growth of eggs in the follicles.
As previously mentioned, because of the effects of FSH and LH, this medication also regulates egg release during ovulation. It is a potent drug and is not typically the first choice for treatment. Its use can lead to complications such as multiple pregnancies or ovarian hyperstimulation syndrome (OHSS).- Aromatase Inhibitors: This medication, letrozole is often recommended for women with PCOS. It helps induce ovulation, similar to clomiphene citrate.
Benefits of Ovulation Induction
Ovulation induction is quite helpful for couples struggling to conceive. Now, women with fertility problems such as irregular cycles or PCOS can benefit a lot from this treatment. Similarly, men with low sperm counts and poor sperm health will benefit a lot as well. This treatment provides a wide range of benefits and opportunities for couples to conceive and finally start a family.Individuals who are going to benefit from Ovulation Induction
Ovulation induction can be beneficial for some women, or specifically, couples who are facing challenges in conceiving. There might be a plethora of reasons for infertility, but people with these challenges will benefit the most from this treatment.- Women facing irregular cycles or skipped periods: Women who are planning to conceive might be facing irregular ovulation or skipped periods. Ovulation induction can be helpful for them as it can regulate hormonal levels and result in healthy ovulation.
- Women with PCOS: A lot of women in recent times have been facing PCOS. This results in a higher level of testosterone in their body, interfering with ovulation and periods. Ovulation induction can be helpful for individuals with PCOS.
- Men with sperm abnormalities: There might be several reasons for men to be infertile, such as low sperm count and unhealthy sperm motility. These couples will benefit a lot from ovulation induction along with some other treatments such as ICSI (intracytoplasmic sperm injection) or IMSI (intracytoplasmic morphologically-selected sperm injection).
Benefits of Ovulation Induction
Ovulation induction possesses several benefits, with the major one being increasing the probability of conception in couples struggling with fertility issues.- Improved probability of conception: This treatment works by stimulating the ovaries to release more eggs. With more eggs, the chances of a successful conception increase significantly. Ovulation induction is extremely helpful for couples facing challenges due to fertility problems. Since the chances of natural conception have been increased, the couples might not have to opt for other advanced ARTs.
- Controlled menstrual cycle and monitoring ovulatory complications: Fertility experts observe the women’s cycle to figure out the accurate time for ovulation. Constant monitoring and estimating the perfect time for ovulation increases the chances of a successful pregnancy.
This is also helpful to find out the correct time for intercourse or other ARTs. Since this method is used to monitor the cycle, it is also helpful in understanding abnormal conditions within the ovary, such as PCOS and anovulation. These conditions hinder the development and release of eggs.- Treatment tailored for the individual: Ovulation induction is usually customised according to the patient’s needs. The dosage of medications and the duration are constantly monitored and adjusted according to the patient's condition. This allows ovulation induction to be a personalised treatment and offers optimum results.
- Fewer complications and cost-effectiveness: This treatment is relatively less complex compared to other ARTs. Methods such as IUI or IVF are more invasive. Ovulation induction uses medication, whether oral or through injections, to stimulate the ovaries to produce more eggs. This makes the treatment quite cost-effective and more accessible for couples to consider for fertility assistance.
How is Ovulation Induction Performed?
Ovulation induction takes a lot of steps to be completed. However, it usually starts with the prerequisites such as assessing the patient's reproductive health, hormonal levels and history of fertility complications. This treatment spans a few detailed phases as discussed below.- Initial evaluation: Patients are assessed before ovulation induction starts. Various factors, such as reproductive health, hormonal levels, and fertility complications, are assessed.
- Assessing hormonal levels: Hormonal levels of the patient are measured by conducting blood tests on specific days of the cycle. Since ovulation is generally regulated by two primary hormones, FSH and LH, measuring their levels is essential, along with other hormones such as oestradiol and AMH.
- Testing the egg count: Determining the egg count and its quality is a necessary step for ovulation induction. This is performed by checking AMH levels, using ultrasound or through antral follicle count (AFC).
- Monitoring ovulation: Hormonal assays or ultrasound scans are used to track ovulation. This is generally done by observing the development of ovarian follicles, which contain the eggs. Once the perfect time arrives, ovulation can be triggered to increase the chances of conception.
- Medications to induce ovulation: Medications such as letrozole, clomiphene citrate, and gonadotropins are used during ovulation induction to stimulate the ovaries and promote the development of the eggs.
- Triggering ovulation: After monitoring continuously and the follicles reaching the perfect size, a shot of human chorionic gonadotropin (hcg) is given to trigger ovulation.
- Timed intercourse: The fertility expert can advise the couple to have timed intercourse or opt for ART, depending on the reason behind infertility. Methods such as IUI and IVF exist whose chances of success can increase significantly with ovulation induction.
- Luteal phase support and pregnancy testing: Once ovulation occurs, the uterine lining must be prepared for implantation. Progesterone support is given to the patient. Now, the final step of ovulation induction is to observe the patient for signs of pregnancy. Blood tests or pregnancy kits can be used if there is a chance of pregnancy.
Risks and Side Effects of Ovulation Induction
As helpful as ovulation induction is for conception, there are a lot of factors that influence whether the treatment will be successful or not. This includes medical conditions that revolve around the reproductive functions of women. There are immense side effects of this treatment as well since it requires a high dosage of powerful hormonal medications. This can lead to several problems, such as headaches, fatigue or abdominal discomfort in some women.Conditions that can complicate the process
There are several medical conditions concerning women’s reproductive functions that can become extremely detrimental to this treatment. Ovulation induction can be complicated if the patient shows symptoms of conditions like PCOS or Endometriosis:- Ovarian cysts: Ovulation induction might be hampered if the patient has massive ovarian cysts. These cysts interfere with the function of the hormonal medications used during ovulation induction.
- Severe endometriosis: The inner lining of the uterus is called the endometrium. When tissues similar to the lining inside the uterus start growing outside it, Endometriosis occurs. Ovulation induction is not the best option for women with severe endometriosis.
- Blocked fallopian tubes: The fallopian tube is the path through which eggs navigate and fertilisation happens. If this tube is blocked, ovulation induction isn't that helpful as the eggs can not move for fertilisation.
- Ectopic Pregnancy: Ovulation induction is carried out with medications such as clomiphene citrate, which increases the risk of ectopic pregnancy. Not all ovulation induction methods carry the same level of risk. However, there are higher chances of ectopic pregnancy associated with this method when compared to the natural cycle.
- Ovarian Hyperstimulation Syndrome (OHSS): One of the side effects of ovulation induction is OHSS. Although this is quite rare among women, it is a severe side effect. So, Women with a history of this condition should not opt for this treatment, as it can result in a higher risk of this condition occurring again.
- Hormonal disorders: Imbalances in thyroid levels or other endocrine complications can interfere with the medication used during ovulation induction.
Side effects of ovulation induction
An individual navigating their way through ovulation induction might face various side effects. Although these side effects can be the result of different reasons, here are some of the most commonly observed side effects of this procedure:- Mood Swings: As strong hormonal medications are used, you might face intense mood swings, anger, irritability or depression. The emotional distress of this method is intense and often requires therapy to deal with the emotional volatility.
- Discomfort in the abdomen and nausea: As the ovaries usually become enlarged during this treatment, some women might face bloating or slight pain in their pelvic region. Due to the intense medications, nausea or the urge to throw up is commonly observed.
- Breasts become tender: As oestrogen levels are spiked up in your body, this results in swelling and tenderness of the breasts.
- Headaches and fatigue: Headaches are common during this treatment due to the rapid change in hormonal levels. Some women also feel tired throughout the treatment period.
- Pain on the Injection sites: Medications such as gonadotropins are usually given through injections. The injection site might become red. Some women observe swelling or pain at the injection sites, too.
- Multiple pregnancies: This procedure increases the probability of multiple pregnancies, such as twins or triplets. Multiple pregnancies can be more complicated and pose a higher risk for both the women and the children.
- Ovarian hyperstimulation syndrome (OHSS): This results in swelling in the ovaries due to overstimulation and can be extremely painful sometimes. This can lead to several complications, such as fluid accumulation in the chest, resulting in breathing difficulties.
Alternatives to OI: Natural Ovulation Aids
There are several methods other than ovulation induction that can be opted for to enhance your fertility naturally. These methods don't require intensive medical intervention and can have a significant impact. Making minor adjustments to your lifestyle, such as regulating your sleep cycle and maintaining a diet that supports fertility health, can enhance your ovulation.Acupuncture improves fertility
This method improves blood flow in the pelvic region, thereby stimulating better circulation to reproductive organs, such as the uterus and ovaries. It also reduces cortisol levels in your blood, the hormone responsible for stress, which can interfere with ovulation. There are numerous benefits to fertility massages. Abdominal massage helps improve the position of the uterus, while lymphatic drainage reduces pelvic congestion. Regulating the sleep cycle
There is a fine connection between your sleep cycle and your reproductive health, including fertility. Melatonin is the sleep hormone which is responsible for protecting the egg against reactive oxygen species (ROS). Sleep disruption can lead to leptin resistance, which in turn can cause ovulation problems. Studies show that there is a higher risk of miscarriage for night shift workers.But what is the ideal time to sleep, then?You should aim for 7-9 hours of healthy sleep. Make sure not to miss the peak melatonin window, between 10:00 pm and 2:00 am. There are specific methods which can help you sleep better, such as sleeping in a room that's neither too cold nor too hot. Circadian rhythm can be improved by daily exposure to sunlight for at least half an hour or by maintaining proper meal times.A balanced diet to promote ovulation
Some foods boost your fertility, such as green, leafy vegetables that promote folic acid and iron levels in the body. Berries are a great source of antioxidants, which are required to protect the egg against oxidative stress. Whole grains help you regulate a stable blood sugar level. However, you should avoid certain food items that can negatively impact your fertility, such as trans fats found in fried junk food. Refined sugars, a key ingredient in sweets, can increase your insulin levels, which may interfere with your reproductive hormonal levels.Ovulation Induction is a crucial procedure that is used along with assisted reproductive technologies (ART) such as IUI or IVF to help women conceive easily. Consulting a fertility expert is advised, as it can help you navigate through this process with minimal risk. The average cost of a single cycle of IUI ranges between INR 5000-6000/- in India. However, you must consult a fertility expert to get an accurate estimate for your treatment.FAQS on Ovulation Induction: Benefits, Process, Side Effects
- What are the success rates for Ovulation Induction?Ovulation induction is quite successful, but the outcome depends on various factors of the individual, such as their age, treatment type and the reason behind infertility. For example, Gonadotropins have a success rate of 20-30% per cycle, while Clomid or Letrozole have a success rate of 10-20% per cycle.
- What is the recommended number of Ovulation Induction cycles?Usually, doctors recommend 3-6 cycles of OI. If pregnancy still doesn't occur, then other treatments such as IVF can be considered.
Disclaimer: Medically approved by Dr Sahana K P, MBBS, MS (OBG) FMAS, PGDMFM (Germany), Consultant - Obstetrics and Gynaecology, Apollo Hospitals Bangalore
