Ovulation Induction :

Ovulation Induction is a term used to stimulate your ovaries to develop follicles. Follicles usually contain egg within them. Ovulation induction can be done either using tablets such as Clomiphene citrate / Letrozole, Follicle stimulating hormone injections or a combination of both.

I was advised Tablets for Ovulation induction. When do I start it?

If your doctor were to advise tablets towards initiating ovulation induction, then you will be asked to start them from either D2 / 3 of your periods for five days. Following this a date will be provided for a follicle tracking scan. Following your scan your doctor might advise you on continuing treatment with FSH injections is he suspects reduced response to the tablets.

How does FSH ovulation induction work ? Follicle stimulating hormone (FSH)  injections are commonly used to stimulate the ovaries to release eggs in women who do not ovulate regularly or have failed to respond to treatment with tablets. FSH  stimulates your ovaries to produce ovarian follicles which have an egg within them.

When should I start my injections ?
You are advised to start your injections on the second or third day of your period bleed. You will need an injection every day. This will be discussed with you during your appointment. The common starting dose of FSH is 75 IU, However this may vary depending on your previous response, BMI, Age etc.  The dose of FSH may be increased or decreased depending on your response. You are advised to take your injections  around the same time everyday.

* Note: The first day of your period is the day you start bleeding heavily.

How is my follow up planned?
You will be asked to return for ultrasound scan to assess follicular development (development of eggs). Follicle tracking scans are generally done between Day 7 – 10 of your periods. Following your ultrasound scan we will discuss about follicular development and medications & dose adjustments if required.
You will be advised on further scans and timings as and when required.

If we have planned for an intra uterine insemination (IUI),  you will be asked to come to the department, with your husband, in 36 hours after HCG injection for the IUI procedure.

What are the reasons behind the ultrasound scans?
This is to ensure your body’s response to the FSH injection is adequate. We will also check the thickness of the lining of your womb (Endometrium).

If there were 3 or more follicles seen on ultrasound scan, the doctor will discuss with you on cycle cancellation and advise you on not having intercourse around the time of ovulation as this increases the risk of multiple pregnancies.

Are there any side effects or risks of taking FSH injections?
The side effects / risks of include cycle cancellation due to a high response, multiple pregnancies, headaches, mood swings, blurring of vision, hot flushes, abdominal discomfort, breast tenderness, nausea and irregular vaginal bleeds.

What next?

Following successful ovulation induction, you will be advised a final injection commonly known as HCG (Human chorionic gonadotrophin). This is used to mature the developed follicle and release the egg. At this point in time your doctor will advise you on Sexual intercourse or IUI (Intra uterine insemination) based on your choice and discussion with the doctor.

Things of note:
If your periods are not regular we shall start you on a course of tablets to induce a withdrawal bleed following which you will be able to start FSH injections on day two.

Please avoid sex till your first follicle tracking scan, failure to do so increases the risks of multiple pregnancies and risks associated with it.