➣ 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
➣ 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.
➣ 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
➣ It is done by the stimulation of egg development by the use of drugs given either by
tablet or injection.
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
➣ 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
➣ 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.
➣ 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
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.
➣ 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
➣ 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.
➣ 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
➣ 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.
➣ 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.
➣ 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
➣ Multiple pregnancy (twins or triplet) can occur
➣ 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.