Trying for a baby: ovulation and ovulation induction

40% of female fertility issues are related to ovulation.

A brief overview of ovulation

The process of conceiving naturally requires both an egg for fertilisation and a sperm to fertilise it. So unsurprisingly, if an egg is not available to be fertilised at the time of intercourse, a couple may experience trouble conceiving. Ovulation is the process by which eggs are released from the female ovary, generally around 14 days before your period.

I am trying to get pregnant – how do I ensure I am ovulating?

For some women, it may be a matter of just tracking ovulation to ensure they are trying for a baby at the optimal time. Some ways to check your ovulation at home include:

• Cycle tracking – you can calculate the length of a woman’s cycle by counting the days from the first day of their period to the day before their next period. You can do this manually or use an app such as Flo. Most cycles are 28 days in length but it could also be anywhere between 24-34 days.
• Ovulation kits – available for purchase over the counter at the chemist, ovulation kits test your urine for surges in Luteinising hormone (LH) levels. These surges generally occur approximately 24-36 hours prior to ovulation.
• Monitoring basal temperature – a woman’s basal temperature will start increasing from when they ovulate to when they menstruate.
• Checking the cervical mucus – just before ovulation, cervical mucus becomes clear and slippery like the whites of a raw egg. This enables the sperm to travel through to the cervix more easily and is the body’s natural way of telling you it is the best time to fall pregnant.

If you are still unable to fall pregnant, there may be underlying problems with the woman’s ovulation that is preventing a mature egg from being released and available for fertilisation. Since ovulation occurs as part of the menstrual cycle, irregular, or absent periods may be a sign that you are having issues with ovulation. In these cases, it is important that you see a specialist to understand your options.

Ovulation induction

Ovulation induction is one of the first line fertility treatments available for women. It involves the use of hormonal medication to stimulate regular ovulation. It may be a good option for you if you have irregular or absent cycles, or unexplained fertility and your specialist has already ruled out the possibility that your fallopian tubes are not blocked.

How does the treatment work?

During the process of ovulation induction treatment, the hormone medication is taken either orally (Clomiphene citrate or Letrozole tablets) or through daily injections of Follicle Stimulating Hormone (FSH). Although they each work in slightly different ways, each of these medications ultimately aim to stimulate follicle growth in the ovaries which affects the number of eggs that are released in each cycle.

Ultrasounds and blood tests will then be used to closely monitor the ovulation cycle and growth of follicles in your ovaries and based on this, your specialist will advise when to have sex in order to maximise the chance of pregnancy.

To further increase the likelihood of achieving a pregnancy, ovulation induction treatment can also be combined with Intrauterine Insemination, which is an assisted reproduction process where sperm is injected straight into a woman’s uterus using a catheter.

Are there any risks?

Like any medical treatment, there are risks associated with Ovulation Induction. If you are going to receive ovulation induction treatment, these are some of the risks that your fertility specialist should counsel you on:

• Multiple pregnancies: stimulation of the ovaries increases the likelihood of multiple pregnancies
• Ovarian Hyper-stimulation Syndrome: there is a chance that you may respond too well to the medication, resulting in overstimulation of the ovaries. This can cause pain, bloating, nausea and vomiting.
• Side effects of the medication: like any medication that acts on hormones, ovulation induction medications may have side effect such as hot flushes and mood changes.

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