Ovulation Induction: First Steps
Once the patient and physician decide to proceed with an ovulation induction (OI) treatment, the patient attends an orientation class. During the physician visit, the patient will also discuss whether timed intercourse or intrauterine insemination (IUI) will be used in conjunction with OI.
CRM offers an OI/IUI orientation class. Taught by a nurse, the class includes:
- Staff introduction
- Treatment timeline
- Medication protocols
- How to mix and administer medications
- Injection and IUI technique
- Post-treatment follow-up
- Support services
- Billing and insurance questions
Types of Ovulation Induction Treatments
Oral Medicated Cycle
After a baseline monitoring ultrasound and blood test at the beginning of the menstrual cycle, an oral medication, clomiphene citrate (Clomid) or Letrozole (Femara), may be prescribed. Beginning around day 10 of the cycle, the patient undergoes a series of blood tests and ultrasound scans to monitor her response to medication and appropriately time intercourse or insemination. The timing is generally dependent on natural ovulation or is induced with an ovulation “trigger.”
Injectable Medicated Cycle
Some OI cycles involve the administration of injected hormones (gonadotropins). These medications are typically taken for 7 to 12 days depending upon the results of near-daily monitoring. The daily dose of medication may be adjusted throughout the cycle to optimize the response. Supplemental progesterone is generally prescribed after ovulation in an injectable medicated cycle.
The physician may determine that neither oral nor injectable medication is necessary to induce ovulation. As in medicated cycles, blood testing and ultrasound scans may be utilized to monitor the progress of the cycle and properly time intercourse or insemination.
The patient may be instructed to administer an injection of human chorionic gonadotropin (hCG) at the time determined by physician review of ultrasound monitoring and blood test results. hCG, a hormone, completes the egg’s maturation and "triggers" the release of the egg from the ovary. If monitoring indicated natural ovulation, hCG trigger may not be required. The hCG trigger can be administered by a nurse or the patient herself.
Semen Specimen Preparation
A fresh or frozen sperm sample from the male partner or frozen donor sperm may be used for IUI. The male partner can produce a fresh specimen at CRM’s Andrology Laboratory on the day of the procedure. Instructions will be provided at the time of scheduling the appointment. If frozen sperm is to be used, arrangements must be made to ensure that the laboratory has the sample in advance of the day of the procedure. The designated sperm sample is processed by the Andrology Laboratory technician prior to the insemination.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a relatively simple procedure in which a catheter is inserted through the cervix to carefully place the prepared sperm sample into the patient's uterus. IUI is a procedure that takes approximately five minutes to perform and does not require anesthesia. The most frequent side effect is mild uterine cramping on the day of the procedure. Intrauterine insemination is typically performed 24-36 hours after ovulation trigger. IUIs are performed daily at the 1305 York Avenue site.
After the Treatment
Confirming Pregnancy Test
Two weeks after the OI/IUI cycle, a pregnancy blood test is performed. Until transferred to the care of an obstetrician, each patient will continue to be monitored by her CRM physician through the first trimester of pregnancy. This monitoring typically includes blood testing and ultrasound.