Fertilitycareclinic.co.uk

Patient Information
Queen’s Hospital
from Burton Centre For Reproductive Medicine, Queen’s Hospital
www.burtonhospitals.nhs.uk
Burton Centre for Reproductive Medicine
Ovulation Induction

What is “Ovulation Induction”?
It is a treatment involving the administration of fertility drugs to stimulate ovarian activity in women
who are not ovulating normally.
What happens in a normal menstrual cycle?
The female reproductive cycle is principally controlled by hormones working together which are
released from several glands in the body.
At the base of the brain, the hypothalamus gland produces a hormone called gonadotrophin
releasing hormone (GnRH). This then stimulates another gland – the pituitary. The pituitary
releases 2 hormones – Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH). Both
these hormones are extremely important and have a direct effect on the ovaries throughout the
menstrual cycle.
FSH stimulates the growth of follicles (a follicle is a fluid filled “cyst”) in the ovary. Each follicle may
contain an egg and produce additional hormones. LH helps FSH to stimulate the production of
these additional hormones, both before and after ovulation.
Approximately halfway through the menstrual cycle as one follicle reaches its maximum size a
sudden surge of LH triggers events which cause the egg to mature in preparation for fertilisation
by the sperm and eventually the rupture of the dominant follicle and the release of the egg. This is
called ovulation.
At this time in the cycle LH is the most important hormone.

The ovaries
The main function of the ovaries is to release eggs and produce hormones. Each month, in a
woman with regular periods who is ovulating normally, one follicle will develop to approximately
20mm in diameter and then release an egg, which will pass into the fallopian tube where
fertilisation takes place. The fertilised egg will begin to divide into an embryo which will then pass
into the uterus (womb) to implant into the lining (endometrium) and develop as a pregnancy.
If the egg does not fertilise, the endometrium will shed and a menstrual period will begin, usually
14 days after ovulation.
The ovary also produces oestrogen and progesterone. Oestrogen is released by the growing
follicle and develops the endometrium. Following ovulation, progesterone is secreted from the
corpus luteum which is formed from the collapsed follicle. Progesterone is important in preparing
the endometrium for pregnancy.
Location: BCRM Master Index/Patient Information Who needs Ovulation Induction?

1. Women with hormonal disorders
If the FSH and LH are imbalanced or inadequate the woman may not produce an egg or fail to
ovulate. This could be accompanied by irregular or an absent menstrual period.
2. Women with Polycystic Ovary Syndrome (PCOS)
Women with PCOS are not ovulating regularly and occasionally not at all therefore it can be more
difficult to become pregnant.

What drugs are required?
Clomifene Citrate - Clomifene is a tablet taken for 5 days usually from day 2 of a period. This is
the most common drug used to induce ovulation. The dose is usually 50-100mg, however, in
some cases if the patient is not responding, the dose will need to be increased to 150mgs. If
Clomifene is not successful at inducing ovulation, more investigations and alternative treatments
may be necessary.
Metformin - It has been recognised for some time that some women with PCOS have
abnormalities with the way their body handles glucose (sugar). This condition appeared to be like
a mild form of diabetes that some people develop in old age - Type 2 diabetes. This type of
diabetes is often controlled with diet alone or diet along with tablets; one of which is Metformin. It
was therefore suggested that these tablets might help in women with PCOS who did not respond
to Clomifene.
There have been a number of clinical trials over the years which initially had conflicting results but
more recently the balance seems to be swinging in favour of its use. If you have not ovulated on
Clomifene we might suggest using Metformin at a dose of 850mg twice a day to see if this helps.
This would be prescribed by your GP as you would need to be closely monitored and the dose
altered accordingly. Many of the trials concluded that in women with PCOS who are overweight,
weight loss produced similar results and furthermore Metformin did not help with weight loss. We
will therefore be suggesting you lose weight rather than use Metformin if this is an issue. Upon
commencing Metformin you might experience some nausea and dizziness but these usually pass
if you continue with the drug
Gonadotrophins - Gonadotrophins provide FSH and LH in various amounts by injection. The
newer preparations can be given by subcutaneous injection (just below the skin surface) rather
than deep into a muscle. Drug therapy is usually started a few days after a period begins and
following a scan. The injections are either daily or on alternate days.
Side effects are rare but can include stomach and bowel upsets, hot flushes, bloating, headache,
dizziness, depression and breast discomfort, nausea and visual disturbance.
Whenever ovulation is induced with fertility drugs there is a risk of a multiple pregnancy due to the
increased number of eggs which may develop. In a natural conception the risk is about 1 in 80. In
ovulation induction the risk is about 1 in 20. There is no increased risk of birth defects from
any fertility drug.
How will my progress be monitored?
Tracking the follicles using ultrasound scan with the use of a vaginal probe monitors progress.
It may also be necessary to do a blood test towards the mid cycle to check the surge of LH which
will give an accurate indication of when the release of the egg is likely.
Sometimes an injection of another hormone – HCG, which acts like LH, is required. This will
encourage the final maturation (ripening) of the egg like LH.
Location: BCRM Master Index/Patient Information A further blood test and scan may be required to confirm that ovulation has occurred. Are there any side effects of treatment?
Generally side effects from both Clomifene and gonadotrophins are rare and of short duration.
Short term and closely monitored treatment is considered to be safe.
However, there are 2 important risks from ovulation induction – Ovarian Hyperstimulation
Syndrome (OHSS) and multiple pregnancy.

1. Ovarian Hyperstimulation Syndrome (OHSS)
OHSS is a rare condition which occurs when too many follicles grow and cause abdominal
distension, discomfort, nausea and sometimes difficulty in breathing.
In extreme cases hospitalisation is necessary. OHSS is potentially very serious, but can be
avoided by careful monitoring.
2. Multiple Pregnancy
Ultrasound monitoring will reveal if more than 3 follicles are developing to a point of maturity. In
such cases, treatment will be suspended as the risk of a multiple pregnancy will be too high and a
consent form will need to be obtained as an agreement to abstain from sexual intercourse during
that period.
What are the success rates?
Success of treatment is difficult to interpret accurately as it can depend on many factors. However,
the average chance of conception after 1 cycle of treatment is between 15 – 25%, it is often
necessary to have more than one treatment cycle before a pregnancy occurs. Success rates are
improving all the time, even in the most difficult of cases.
If I get pregnant will my baby be healthy?
The chance of having a miscarriage or a baby with abnormalities is the same following ovulation
induction as after a natural conception.
Taking folic acid supplements is recommended for all women planning a pregnancy to help reduce
the risk of some birth defects.
Please note: Some therapies are dependant on local funding criteria and eligibility will be
assessed in advance of treatment offer.
Location: BCRM Master Index/Patient Information

Source: http://www.fertilitycareclinic.co.uk/data/documents/0431.0806%20Ovulation%20Induction.pdf