Growing Eggs

What is Ovulation Induction (OI)?

Also called “Ovulation Induction” or “OI”

OI is a fertility treatment that uses fertility drugs to encourage egg release from the ovaries. Fertility medications are usually given to increase the growth of eggs in the ovaries and may also be required to cause ovulation or release of the eggs from the ovaries. Your fertility doctor will advise which medication are right for you. The clinic monitors how your eggs are growing and when your eggs are likely to be releasing or ovulating, so that we can guide you on the ideal timing to be sexually active to try and achieve a pregnancy.

Who might need OI treatment?

OI is useful for many situations. It is commonly suggested as a treatment:

  • If a couple has a short history of unexplained infertility, that is all the tests cannot identify a cause for their infertility
  • If the female partner has PCOS or another condition causing difficulty with egg growth and release
  • If the female partner has mild or moderate endometriosis
  • If the female partner has one blocked tube (or absent tube) and one open tube on testing
  • In women over 40 years wishing a pregnancy

How do I start my OI treatment?

Once you have been seen by the doctor and have been booked for OI treatment you can start your OI at any point in the following 12 months. An OI treatment always starts with a period. You will need to call the fertility unit (622 8869 or 662 8344) on the day your period starts and will need to come in the following day for a scan. When you call us, we will let you know which clinics are open for scans. If your period starts on a Sunday please call and leave a message (662 8344 or 622 8869) telling us that your period started and that you are coming in for a scan on Monday. All scans are done between 7.00 and 8.00 am Monday - Friday (both clinics) and 8 - 9am on Saturdays (Medical Associates clinic only), on a first-come first-served basis. If you arrive after this time then there may not be staff available to perform your scan and you will need to come back the next day.

FIRST MONITORING VISIT Attend the clinic on day two of your period for a vaginal scan and oestradiol blood test by the clinic nurses. You will be given your fertility medication (Clomiphene, Letrozole or the stronger FSH injections) and asked to wait for a phone call later that day to confirm that your results are normal and to start your fertility medication that night.
If your scan and hormone blood test are normal, then start the fertility medication as advised by the nurses and return for your second scan as advised.


SECOND MONITORING VISIT Attend the clinic as advised by the clinic staff for your second vaginal scan and oestradiol blood test to see how your eggs are growing. This visit is usually
• on day 9-12 of your cycle (Day 1 of your period = day 1 of your cycle) if you are on fertility tablets • on day 6-8 of your cycle if you are on FSH fertility injections
Our clinic doctors monitor all the results and depending on these results you will be given information by your clinic nurse on how your eggs are growing. Often the eggs are not quite ready yet and you will be advised to do some home urine testing and come back for a third (and occasionally a fourth) monitoring visit. Sometimes the eggs are ready and you are ready to be sexually active and try to achieve a pregnancy, at other times the eggs might need an injection to help them release so that you can be sexually active and try to achieve a pregnancy.

HOME URINE TESTING & THIRD MONITORING VISIT (IF NEEDED) Urine testing is often advised at your second (or later) monitoring scan if the eggs are growing well, but not looking mature and ready to ovulate just yet. The urine tests that we give you look for the hormone LH being released in your urine. This LH hormone is released 24-48 hours before the egg(s) ovulates. Usually we will give you between 2-5 days of home testing and then ask you to return for a third monitoring visit if you have not released any ovulation hormone. If you do release the LH hormone then we will advise on sexual activity to try and achieve a pregnancy within 12-24 hours of a positive LH urine test.

If you need to return for a third monitoring visit, then the vaginal scan and blood test are looking to see if the eggs are growing properly and you will be advised what is needed later that day when the results are received and reviewed by the doctor.

What are my chances of getting pregnant with OI treatment?

The doctor will discuss your success rate with you in clinic and recommend how many OI cycles you should consider.

Each time an OI is done the chance of becoming pregnant is between 1 - 30%. This will vary depending on your personal circumstances and will be lower particularly in older women (40 years and over), women with very low egg levels and in women where the quality of the eggs or tubes is not thought to be good.

If both your tubes are blocked there is almost no chance of pregnancy with OI. This is why the clinic will usually ask you to have a tube x-ray before OI treatment. If the sperm quality is poor this also reduces the chances of a pregnancy with OI treatment, which is why a recent sperm test is required before OI treatment is started.

What medications are used to grow eggs and help eggs ovulate?

The doctor will discuss your medications with you in clinic and recommend the fertility drugs that are suitable and most likely to work for you.

Fertility tablets used to grow eggs are Clomiphene Citrate (also called Clomid, Clostril or Serophene) and Letrozole (also called Femara). These are usually given for five days only from day 2 of your cycle.

Fertility injections to grow eggs are FSH medications and are often given for longer than five days – sometimes up to fourteen days, depending on how you respond to them. The available options are the pre-filled Gonal f injection pens or the Menopur ampoules that require mixing by the patient before injection. The fertility injection to help eggs ovulate is called Chorgon or Ovidrel and is given as one injection only when the eggs and the lining of the womb are mature and ready.

What are the risks of OI?

Having an OI is a very safe and simple fertility procedure. There is an increased chance of having a multiple pregnancy, such as twins, of around 2 to 5%. This is more likely if fertility injections have been used to encourage egg development and over five eggs grow. There is also a tiny (1/1000) chance of getting overstimulation of the ovaries OHSS. OHSS or ovarian hyperstimulation syndrome is a condition often requiring hospitalization, with many cysts on the ovaries and fluid in the abdomen.