Ovulation induction and IUI instructions

The goal of ovulation induction treatment is to achieve ovulation for females who are unable to do so on their own, or if their ovulation does not meet the criteria that is considered “normal”.

“Superovulation”, on the other hand, is a term used when the objective of inducing ovulation is to achieve multiple eggs at one time. Obviously, there is an increased risk of multiple pregnancies when more than one egg is released.

Superovulation is advised in association with any of  the following two scenarios:

1. In women older than 37 years of age, or those with an elevated FSH and when there is a possible decline in egg quality and number. In these cases, an increase in the number of eggs released can compensate for the corresponding decline in egg quality.  There is a significant risk of twin pregnancy in this scenario (up to 20%).  We need to keep the number of mature follicles less than 5 in order to minimize the risk of higher-order multiple pregnancy i.e. more than twins.
2. In couples undergoing IVF, we do more aggressive stimulation since the success of IVF, to a large extent,  depend on the number of mature good-quality eggs retrieved which would be translated hopefully to the good number of good-quality embryos.  We are not too worried about multiple pregnancy here since we control the number of embryos that will be returned to the uterus.

All ovulation induction drugs work by either increasing the patients’ own FSH (oral meds including Clomid or Letrozole) or by providing exogenous (already made from an outside source) FSH (injectables like Gonal F, Puregon, Menopure/HMG). It is the injectable drugs that achieve superovulation. Injectables can also be used for a small percent of patients who are resistant to oral medications in order to achieve single ovulation (monofollicular development).

Careful monitoring and dose adjustment are mandatory for safe ovulation induction, especially when injectables are used. Proper timing of the ovulation trigger is mandatory for proper egg maturation, to deliver the sperm at the ideal time, or to time when to collect the eggs in cases of IVF treatment.

Proper monitoring and frequent dose adjustment with proper, timely communication are mandatory for safe and successful treatment.

Ovulation induction treatment is usually continued for 3-4 cycles.The success rate per cycle is in the range of 10-30% per cycle. Success depends on the age of the patient, the number of eggs released, sperm quality and other associated factors that can influence the success rate. A review with your doctor will usually be booked if no pregnancy occurs after the third cycle, or sooner if a change of plans is requested or indicated.

Instructions

1. Call or e-mail your nurse when your period starts (cycle day #1). Please refer to nurses contact provided to you or access your contact on the website
2. Ensure you have communicated with your primary nurse before you come to the clinic on cycle day 2 or 3 as directed. Consents and medications or prescriptions will be prepared for you.
3. Please be aware of our clinic emergency after-hours phone line (416-508 9814), you can call this line until 8:30 pm.
4. There are no restrictions on what you can do during your treatment cycle. You can continue with your usual daily routine, including frequency of intercourse, unless you are told otherwise.
5. During the cycle, you will get  constant feedback about your progress and any changes regarding the frequency of visits or dose changes from your primary nurse based on your doctor’s advice.
6. Please take your meds after 8 pm. Your advice regarding dose change or trigger of ovulation is expected before 8pm. If no call or e-mail is received, then stay on the same dose and come back to the clinic at the time you were already scheduled for.
7. Your treatment with fertility meds/monitoring ends by receiving the ovulation trigger (Ovidrel or HCG).
8. Sperm delivery (intercourse or IUI) should occur within the following 36-48 hours.
9. For IVF patients, egg retrieval occurs precisely 35-36 hours after Ovidrel/HCG shot.
10. Progesterone supplementation will start 48 hours after Ovidrel.
11. Pregnancy testing will be scheduled 14 days after your trigger. Further specific instructions may be communicated on an individual basis.
12. A review appointment may be set for you by your nurse at the end of 3  treatment cycles of ovulation induction or sooner if indicated or requested. Cycle to cycle protocol modification may occur to optimize your stimulation and treatment outcome.
13. Please take the time to fill an evaluation form regarding services received during your cycle so that we can improve our services based on your perception, feedback, and guidance. We strive to meet and exceed your expectations! These evaluations are collected at the end of each treatment cycle.