If you have any questions, please contact Sr. Helen Butt, Sr.

Janet Wighton or SN Kate Guyton or one of our fertility nurses on Jasmine Ward.

 01935 384301 (Direct line)

Ovulation Induction & Intra-Uterine Insemination

Department of Gynaecology

Leaflet No. 6500807 07/07

Ovulation Induction
One of the first options in the treatment of infertility is ovulation induction. The procedure involves giving fertility drugs to stimulate ovarian activity in women who may not ovulate normally. Who Is Suitable

Is there anyone I can talk to Undergoing fertility investigations and treatment can be very stressful on the individual and as a couple. If you feel that you want to talk to someone about how you feel, you can either contact one of the nurses on (01935) 384301.

Women who do not ovulate Women with hormonal disorders Women with polycystic ovarian syndrome

Fertility Drugs
Clomiphene Citrate The most common drug used in the induction of ovulation is Clomiphene Citrate. The treatment involves a course of tablets taken usually for 5 days in each cycle. If ovulation has not occurred (results known after a blood test), the dose may be increased for following cycles. Results show that 4 out of 5 women given Clomiphene do ovulate, but only 1 in 3 actually get pregnant. Side Effects

Reported side effects are: Abdominal discomfort Headaches Abdominal bloating Hot flushes Nausea and vomiting Breast discomfort Visual disturbances Dizziness Depression/insomnia

Multiple pregancy is a risk (about 1 in 20) when ovulation is induced with fertility drugs. There is no evidence that fertility drugs increase the risk of birth defects.

Why treatment may be stopped Ocassionally this happens because of one of the following:

Gonadatrophins If Clomiphene has not been successful within 6 months, the next option is gonadotrophins. Gonadotrophins are powerful injectable drugs which require careful monitoring. When does treatment start Treatment needs to be started a few days after the start of a period. If a woman does not have periods or has a very irregular cycle, it may be possible to induce a period prior to commencing treatement. What does treatment involve This involves having daily (or alternate days) injections at a dose determined by a fertility specialist. Careful monitoring of the response to treatment is a vital part of the programme, to maximise the chances of a successful pregnancy and minimise any risks. Monitoring is done by ultrasound. A number of scans will be performed during each cycle. Drugs used to stimulate the ovaries Gonadotrophin Injections These are known as follicle stimulating hormones FSH. Most women are prescribed GONADOTROPHIN which may be self injected. Instructions on using the injection pen are given by the fertility nurse on request. Human Chorionic Gonadotrophin (HCG) Injection This is a final injection given when the ovary has at least one but no more than two mature follicles. HCG releases the eggs from your follicles 34-36 hours following its administration. Timed intercourse to coincide with ovulation is crucial.

Follicles and/or endometrium have not grown to optimum size. You have had an adverse reaction to the drugs and become hyperstimulated. There are too many mature follicles and the risk of a multiple pregnancy is very high. In this situation the nurse/doctor will discuss the scan result with you and advise on the best course of action. Your follicles have ruptured prematurely.

If your treatment is stopped because you have overstimulated, you will not normally be given a HCG injection. You may be offered another attempt at IUI at a later date if this is thought to be an appropriate fertility treatment for you and your partner. What if I am pregnant You will be offered an ultrasound scan, normally during the 7-8th week of pregnancy. This scan shows:

The number of embryos. That the embryo has implanted in the uterus. That the embryo is viable - this means a heartbeat can be detected.

What about miscarriage Becoming pregnant following ovulation induction does not in itself increase your chances of miscarrying, nor does it increase the risk of conceiving a baby with an abnormality. However, multiple pregnancies, whether or not concieved after fertility treatment, carry a slightly increased risk of early miscarriage and you may be given special advice by the doctor if this applies to you. What about sex during the week up to treatment The quality of sperm can be reduced if your partner does not ejaculate on a regular basis. Because of this it is NOT a good idea to avoid intercourse during the weeks leading up to your treatment in the hope of saving up sperm. It is best to have intercourse as normal unless advised otherwise.

Ultrasound scans These are usually performed vaginally to monitor the growth of the follicles developing on the ovaries. The thickness of the womb lining (endometrium) is also measured as this is where a fertilised egg will implant (you will be scanned on day 3-4 of your treatment cycle, then several more times throughout treatment). This involves inserting a small probe into the vagina. This should be pain free and does not necessitate a full bladder. You may have your partner, a friend or relative with you during the scan. Intra-uterine insemination (IUI) This is assisted conception used to achieve a pregnancy in couples with a fertility problem. It is used in cases of unexplained infertility; if the female partner does not ovulate regularly; or in some types of problems with the sperms. Couples receive up to 3 IUI treatment cycles and it is successful approximately in 510% of the total treatments carried out here. What IUI involves For most couples, IUI treatment involves stimulating the females ovaries with fertility drugs so that they produce follicles containing ova (eggs) and treating the males semen so that it is concentrated and contains the most healthy and active sperm. The treated semen is then inseminated into the females uterus. How is the actual IUI carried out On the day after your HCG injection, your partner will be required to produce a sample of semen. The sample must be brought to the hospital a number of hours prior to the IUI treatment so it can be prepared. A time to attend the gynaecology ward for the insemination will be given to you. Here, the fertility nurse will meet you and explain the entire procedure. A doctor/nurse will insert an instrument into your vagina. This gives a view of the cervix into which a fine catheter is passed. Once this is in place, you partners treated semen is injected in the uterus. The insemination should be relatively pain free and completed in a few minutes. You will be able to go home approximately 30 minutes later after resting, with full instructions from the fertility nurse.

And afterwards We advise you to continue following our pre-conceptual care quidelines in hopeful preparation of a pregnancy. When will I know if treatment is successful If you are not pregnant, your period will normally start within 14 days after the IUI - atthough it may be slightly later. If your period is more than 5 days later, there is a high possiblility you are pregnant. This is the time to perform a pregnancy test. Please let us know the results of your IUI by telephoning the fertility nurse on (01935) 384301. Are there any side effects to look out for Slight bruising is common from gonadotrophin . This is a normal reaction and will fade within a few days. Ovarian hyperstimulation syndrome (OHSS) Very occasionally (about 1-5% of all treatment cycles) women having fertility drugs, especially gonadotrophin injections, to stimulate ovulation, develop a condition known as ovarian hyperstimulation syndrome (OHSS). With most women the condition is mild, but when OHSS is severe, large amounts of fluid collect in the abdomen and this leads to thickening of the blood in the arteries and the veins. In very rare cases OHSS can be life threatening. OHSS is more common in women who have polycystic ovarian syndrome. Women most likely to get OHSS are those who produce a large number of follicles during their treatment cycle. This will be seen on your ultrasound scan. If this should happen to you, we shall warn you of the symptoms and risk of OHSS and will normally end the current treatment cycle. You will not be given your HCG injection as we want to avoid all the follicles rupturing at around the same time. Without the HCG injection, the follicles rupture gradually over the next few days. The signs of OHSS are most likely to show 5-7 days after your last injection and there may be swelling of the abdomen with discomfort and pain and bloating with or without nausea and vomiting. Sometimes the soft skin around the vaginal opening (vulva) swells considerably. This is harmless and will soon decrease. If you experience these signs, you must start to drink large quantities of fluid - isotonic sports drinks are the best. Telephone your GP and tell them that you are taking fertility drugs or contact the fertility nurse. You may need to come into hospital for a few days for monitoring and treatment.