Ovulation Induction

Regular ovulation is the basis of natural conception. When ovulation is weak or irregular, periods are usually irregular or far apart, and pregnancy is delayed even if every other test is normal.

Who is ovulation induction for?

• Polycystic ovary syndrome (PCOS): the most common cause of ovulation problems.
• Hormonal disorders, such as high prolactin or a thyroid disorder, once they are treated.
• Unexplained infertility, sometimes combined with intrauterine insemination.

Modern treatment options

• Lifestyle changes: in PCOS, losing 5 to 10% of body weight can bring back normal ovulation on its own.
• Letrozole: now the first choice for ovulation induction in PCOS under the 2023 international guideline, because pregnancy and live birth rates are higher than with clomiphene.
• Clomiphene: still a suitable option for some cases.
• Hormone injections (gonadotropins): for women who do not respond to tablets. They need closer monitoring.
• Metformin: may be added when there is insulin resistance.

Ultrasound monitoring: the key to safety

The follicles are followed with transvaginal ultrasound (follicle tracking) to see how many are growing and how large they are, adjust the dose, and time the trigger shot and intercourse precisely.

This monitoring lowers the two main risks of stimulation:

• Multiple pregnancy when many follicles grow.
• Ovarian hyperstimulation, which is rare with the right doses and regular monitoring.

If ovulation happens for several cycles without a pregnancy, the plan is reviewed and the next step is considered, such as intrauterine insemination or ICSI, depending on the case.