Posted under Fertility Treatment by Dr. Rajeev Agarwal


Understanding Ovulation Induction. Why is it important in fertility Treatment?

Every Couple facing Conceptions issues are given medicines/ injections to help them ovulate. Ovulation Induction is key to conception success whether via Times Intercourse (natural conception) or via IUI or IVF. Find out why it is necessary and how does it help in IUI and IVF.

What is Ovulation Induction?

Ovulation Induction is a part of Fertility treatment where the ovaries are induced to produce large no of eggs with the help of fertility medicines of fertility hormone injections. It is used as a part of fertility treatment in women with irregular menstrual cycles to improve the chances of either artificial conception or Natural conception.

Why is Ovulation Induction needed?

In Natural Conception:

Induction of ovulation is indicated in women who do not ovulate (produce an egg) normally.

Ovulation induction allows women who do not ovulate normally, an opportunity to ovulate and have a chance at conceiving. Conception success depends on timing the intercourse to take place when ovulation occurs. In women who do not ovulate normally, this becomes a problem. In such women, Ovulation Induction followed by monitoring helps them to identify the fertility window and have intercourse during their best fertility days.


The most important step in IVF treatment is harvesting a good number of oocytes or Eggs from the wife. 

In a natural conception cycle, only one egg is released every month from any one of the ovaries. Since IVF treatment is an expensive and time taking process, we attempt to increase the number of eggs that can be released from the Ovaries. The more eggs we can harvest the more embryos we can make and thus the more no attempts we get to transfer the embryos. To improve the productivity of ovaries or we need to induce them to produce more eggs “Super Ovulate” with the help of fertility medications. This process is called “Ovulation Induction”. OI is done by administering a daily dosage of fertility medications to stimulate ovaries to produce one or more eggs and by tracking the response to the medications via follicular monitoring of the ovaries. Follicular monitoring involves a series of TVS scans of the ovaries during the Ovulation Induction cycle to check how many follicles have been recruited and how they are growing. If Oral Medications fail to bring out the desired response, injections of FSH/HMG are prescribed when tablets have not caused an egg to become big and mature enough for fertilization.


  1. In a woman with normal ovarian reserve, every cycle approximately 10 -15 follicles are recruited in which oocytes can develop but in the need only of the follicles will produce a mature egg that will be released during ovulation. The rest of the follicles will degenerate. In a woman with poor ovarian reserve, sufficing no of follicles is not formed and thus ovulation doesn’t happen. This in Women with poor egg count needs to be stimulated to produce sufficient follicles so that at least one of them will be able to release a mature egg that can be fertilized by semen injected via Intra Uterine Insemination.

Significance of Ovulation Induction in IUI and IVF Treatment:

The success if IUI/ IVF treatment depends on the outcome of Ovulation. Ovulation Induction gives clinicians to chance to monitor the patient's response to the treatments which is vital to maximizing the chance of a successful pregnancy and to minimize the risks of the treatment. It also enables clinicians to modify the drug dosage as and when required.

Conditions associated with failure to ovulate include:

(a) Hormonal Imbalance

If there is an imbalance in the release of Follicle-Stimulating Hormone (FSH) and luteinizing hormone (LH) from the pituitary gland in the brain, a woman's ovaries will fail to produce an egg (ovulate) each month. Women who do not ovulate regularly tend to have irregular periods and may fail to menstruate. A known cause of hormonal imbalance is severe weight loss.

(b) Polycystic Ovary Syndrome (PCOS)

This is a condition in which the ovaries of affected women contain small cysts of about 2-8mm diameter, which are easily detectable by ultrasound scan. It is a fairly common cause of irregular periods and affected women may not become pregnant, because they are not ovulating. It is believed that this condition arises because of the inability of the ovaries to produce hormones in the correct proportion. Fertility drug treatment with tablets or injections of Fertility drug treatment with tablets or injections can usually induce ovulation in these women.

(c) Weight and Body Mass Index (BMI)

A high weight height ratio has a significant adverse impact on reproduction outcomes. It influences the chance of conception, response to fertility treatment and makes monitoring of treatment suboptimal.

Which drugs are used for the induction of ovulation?

1. Letrozole

This is the most commonly used drug for induction of ovulation and it is administered via tablet form for 5 days. Over 80% of women who are given letrozole will ovulate but only about 1 in 3 actually become pregnant.

Side effects of treatment with Clomifene Citrate are rare but some women complain of tummy and bowel upset. There is always a risk of multiple pregnancies when fertility tablets are prescribed. Abnormal uterine bleeding and enlargement of the ovaries can occur.

2. Gonadotrophins

Gonadotrophins are administered by injection and are useful in women who fail to respond to letrozole treatment, especially women with Polycystic Ovary Syndrome (PCOS). Gonadotrophins provide follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in various amounts. Treatment with gonadotrophins is usually started after a baseline scan of your ovaries, within the first 3 days of your cycle. Women who do not have periods may be given hormones to induce menstruation. The length of treatment and the dose of gonadotrophin given will vary from patient to patient, depending on how your ovaries respond

What happens in the Ovulation induction procedure?

  1. Medications begin at the start of the menstrual cycle to encourage eggs to mature. Usually, these are gonadotrophin injections stimulating the ovaries to produce egg sacs/follicles and cause ovulation or egg to mature.
  2. 5-7days after treatment has commenced, you will be asked to have regular ultrasound scans to check the growth of follicles and when the scan shows an adequate number of follicles that have reached their target size, a final injection, will be administered to cause the release of eggs from the egg sac.
  3. You will be advised by the unit staff of the likely timing of ovulation and advised to have regular intercourse over the next couple of days.
  4. You will be asked to carry out a pregnancy test two weeks following the trigger injection unless your period has already started.
  5. If the test is positive, we will arrange a scan for you in a couple of weeks to ensure all is well.
  6. If the test is negative, then our inhouse doctor will contact you to offer support and the way forward if you wish to proceed with another cycle of treatment.

Risks of Ovulation Induction:

The risks involved in having Ovulation Induction are:

  • Ovarian Hyper-Stimulation Syndrome
  • Multiple pregnancies
  • Hot flashes
  • Headaches or blurred vision
  • Mood swings
  • Breast tenderness
  • Nausea

What are the benefits of Ovulation Induction at Care IVF?

Our Inhouse gynecologists have been trained under the best fetal medicine-radiology team who are venerated for their expertise in Fertility and obstetric scans. Care IVF is one of the best centers for Follicular monitoring which is an important part of checking the response to Ovulation Induction.

Care IVF is best known for the strong counseling team that provides patient support. The group of counselors and coordinators work parallelly with doctors and their respective patients providing them continuous support throughout the day. Their counseling services include providing guidance regarding the next step, explaining the medications that patient needs to take and their dosage, preparing them for the scans, tests and pick up procedures. The counselors are one call away and continue to provide SOS support after hours. The Counsellor can be contacted for support at any time, throughout your treatment and afterward.

About the author

The author, Dr. Rajeev Agarwal is a Fertility Consultant at Care IVF Kolkata. For an appointment with the doctor, call +91-33-66-398-600. You can also book a Skype Consultation here.


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