Superovulation with injectables and Follicular Monitoring

What is Superovulation?

➣ In simple terms it means producing an egg from an ovary in addition to release of egg naturally. The purpose of superovulation induction is to develop a two to three follicles to maturity and to ensure that it develops well

What happens in a normal menstrual cycle?

➣ In a young woman with regular cycles, one egg is released per month from the ovary.
➣ Many eggs are selected from a pool of sleeping follicles and one is selected naturally. It grows due to the hormonal changes and by the fourteenth day the egg is released. If this egg meets a healthy sperm, it gets fertilized and a baby is formed.

Who needs ovulation induction?

➣ A woman who does not produce an egg naturally needs this treatment or even with normal ovulation if not conceiving, injection increases the quality and the chance of conception

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.

What are the pre requisites?

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 fertilization will take place)
3. The ovary must be capable of producing an egg in response to the stimulation provided

How is ovulation induction done at A4 fertility center?

➣ It is absolutely essential that a sperm count and a test to assess the likely response of the ovaries be carried out.
➣ To gauge the likelihood of the ovaries responding to the stimulation we carry out a blood test to measure the Antral follicle count on day 2 or 3 of the menstrual cycle or anti mullerian hormone levels (AMH) on any day of the cycle, the latter being done in selected women only.
➣ If there are no indications in the medical history of any problems with the fallopian tubes e.g. history of pelvic inflammation, then a test for tubal patency may not be carried out in the initial phases of treatment.

Treatment process

➣ If the periods come infrequently we induce a bleed by giving a 5 day course of Progesterone , because to wait for a period to come naturally might mean waiting a long time

Drugs used to stimulate ovulation:

Two main types of drugs used in ovulation induction:
➣ Anti - Estrogens (Clomiphene 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 pituitary 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.

Supplements :

➣ There are some medicines which your consultant might add such as Glycomet (Metformin 250-1000 mg), Myoinositol (Tritositol / APCOD-OBIS) to improve ovulation. These facilitate the above mentioned oral medicines and injections

How is the cycle monitored ?

➣ 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.

How is follicle tracking carried out?

➣ The best way of looking at the ovaries is by ultrasound carried out using a vaginal probe. This method of scanning provides the most accurate image of the ovaries. A probe is inserted into the vagina (similar to having a smear taken from the cervix but usually less uncomfortable). The procedure is carried out with an empty bladder, takes no more than 10 minutes and also allows us to see the womb, its cavity and the lining of the womb

When do I know the follicle has grown?

➣ You would be intimated by the consultant if your follicles are growing or not during the scans. You may require further injections if the follicles are not growing adequately.

What is the success rate of this treatment?

➣ 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, provided there are no other causes for the infertility, will be close to the rate of natural conception in a woman who ovulates normally. This is about 20 % per cycle. We will review the treatment at the end of every month and decide what the next course of action is. We may continue with this treatment for a number of cycles.

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

What should I do as a patient?

➣ You should ring the Centre when your period starts and book your scan with Reception, explaining what the purpose of the scan is. i.e. “follicular monitoring” , inform your ID number and consultant . ➣ Carry an extra sanitary napkin and underwear ➣ We always believe in shared responsibilities and patient satisfaction. Communicate to our staff at A4 fertility center and we will be glad to help you with any other enquiries.