Every woman is born with a lifetime's supply of egg cells in her ovaries. Each egg cell is contained in a small sac called a follicle. Follicle stimulating hormone (FSH) and luteinising hormones (LH) are two hormones produced by the brain to stimulate and regulate the monthly release of an egg. At the onset of puberty, one egg from an ovary is released every month until menopause (cessation of periods). Each egg released is picked up by the adjacent fallopian tube. The egg can be fertilised by a sperm and lead to pregnancy or, in the absence of sperm, it will dissolve and be flushed out with the menstrual flow. Each stage of ovulation is governed by many hormones secreted by the hypothalamus, pituitary gland, adrenal gland, thyroid gland and ovaries.
This process of ovulation and its timing within the menstrual cycle plays a key role in determining fertility and achieving pregnancy. A normal menstrual cycle is between 28-32 days, measured from the first day of period to the first day of the next menstrual flow. Some cycles may be shorter or longer. Ovulation usually occurs on the 11th to 21st day, starting from the first day of the last menstrual period (LMP). This is considered a fertile period when couples wishing to conceive can have intercourse and increase their chances of pregnancy.
Many conditions that affect ovulation can lead to infertility. These may include:
Being the most common ovulation disorder that causes infertility, PCOS affects 5-10% women of childbearing age.
Ovulation disorders disrupt or prevent the ovulation process and can thereby lead to infertility. It is a cause of infertility when associated with irregular or no periods (amenorrhea). It is rarely a cause of infertility when associated with regular menstrual periods without premenstrual symptoms, such as mood swings, breast tenderness or lower abdominal swelling.
Eggs are contained in two small oval-shaped ovaries present on either side of the womb in the pelvic region. At the time of ovulation, one mature egg is released from the ovary and picked up by finger-like structures at the ends of the fallopian tube. The tube then transports the egg to the womb.
Ovulation disorders occur when one part of the ovulation process malfunctions. This can happen when:
Ovulation problems may occur as a result of a disorder such as
You may be at a risk for ovulation problems if you have the following:
The signs and symptoms of ovulation problems depend on the related disorder and may include:
Ovulation induction is associated with PCOS, diabetes and infertility.
When you visit your doctor with problems in your menstrual cycle or inability to attain a pregnancy despite trying without contraception for a year, your doctor will review your menstrual history and perform a thorough physical examination. You may be asked to record your daily body temperature as an increase in your body temperature indicates ovulation. This can also be performed using a home ovulation predictor kit. Other tests may include ultrasound or blood tests.
Left untreated, you may not be able to have biological offspring.
Ovulation problems can be treated with lifestyle changes such as diet and maintaining a healthy weight. Other treatments may include:
You will be considered for ovulation induction if you suffer from:
The required pre-requisites for ovulation induction are:
Before ovulation induction, your doctor will suggest:
Ovulation induction involves the following steps:
After confirming positive for pregnancy, your doctor will continue to monitor the progress of your pregnancy with weekly hCG tests for about 8 weeks of pregnancy. Then, an ultrasound is performed to determine the presence of a pregnancy sac with a foetus and the presence of a foetal heartbeat.
The advantages of ovulation induction are:
Ovulation induction helps release a healthy egg for fertilisation or multiple eggs for IVF treatment.
Some of the potential risks of ovulation induction are
Ovulation induction is started on the third day of your menstrual cycle for about 7 to 10 days. This may continue for a few cycles until you achieve pregnancy. However, this does not require you to be off work. You can go about your normal routine.