For the Woman

Ovulation Induction

Elevate Your Odds of Conception

Ovulation induction is a term used to describe the use of oral or injectable fertility medications (gonadotropins) to stimulate the ovaries to produce mature eggs. The purpose of ovulation induction is to develop and ovulate one or more eggs in a woman who normally does not ovulate. Based on your diagnosis, your doctor will prescribe the treatment most appropriate for you.

Ovulation induction is indicated if you:

  • Have ovulation problems that have not responded to simpler medications (such as clomiphene citrate).
  • Have unexplained infertility and wish to try ovulation induction in order to increase the number of eggs produced in each cycle. With increased egg production the chance of conception also increases.

To be a candidate for ovulation induction you must have a normal uterine cavity, and at least one normal fallopian tube, and your partner must have a normal sperm count.
In the general population, 20% to 25% of healthy, fertile couples become pregnant each month that they are trying to conceive.1 In our experience, ovulation induction typically produces pregnancy rates of 10% to 20% per cycle, depending on a woman’s age, diagnosis, and duration of infertility. Approximately 15% to 20% of gonadotropin pregnancies will miscarry, similar to the general population.2

1American Society for Reproductive Medicine, Age and Fertility, Fertility in the Aging Female, 2012
2Journal of Human Reproductive Sciences, Publication of Indian Society of Assisted Reproduction, Comparative evaluation of pregnancy outcome in gonadotrophin-clomiphene combination vs clomiphene alone in polycystic ovarian syndrome and unexplained infertility–A prospective clinical trial, May-Aug 2010

Intrauterine Insemination (IUI)

IUI, or artificial insemination, is a common fertility treatment used for a variety of infertility issues. It is considered a less invasive approach, than some other ART (Assisted Reproductive Technology) procedures, because the critical steps necessary for conception must occur as they naturally would, without any medical assistance.

What Happens During IUI

  • During the course of a gynecological exam, the physician will insert a thin, flexible catheter through the patient’s cervix into her uterus to deposit a sperm sample. This insertion is painless and the patient can resume her daily activities within minutes.
  • The sperm inserted into the patient’s uterus has been washed in the laboratory to rid it of seminal fluid and to concentrate it.
  • The sperm can come from the spouse (artificial insemination with spouse’s sperm – AIS) or from a donor (artificial insemination with donor sperm – AID).

Indications for IUI Using a Spouse’s Sperm

  • Male infertility problems associated with a low sperm count or with sperm or morphology problems.
  • Male infertility following a cancer treatment (when the patient has planned ahead and has had sperm frozen prior to his treatment).
  • Repeated failures with ovarian stimulation.
  • Unexplained infertility.

Indications for IUI Using a Donor’s Sperm

  • Major sperm abnormalities, such as a total absence of sperm.
  • Hereditary genetic diseases or infectious diseases that could be transmitted to the spouse.
  • Isoimmunization or other problems.
  • Male infertility following a cancer treatment.

The donated sperm comes from donors who have donated sperm to the Procrea Fertility Cryopreservation Center sperm bank, or to any other sperm bank inspected in accordance to Health Canada standards. Learn more about Procrea Fertility Cryopreservation’s overall selection requirements, including how donors are selected, in the Sperm Donation section of the site.

A session with a psychologist/psychiatrist who specializes in fertility issues is mandatory when using a donor for the artificial insemination process. This session will provide you with the opportunity to discuss common issues concerning this type of insemination, and to help you work through any concerns you may have prior to undergoing the procedure.

Procrea Fertility patients receive a general documentation when they embark upon their treatment journey.  You will also receive detailed information from your physician once you have determined together that IUI is the best course of treatment for you.

In Vitro Fertilization (IVF)

By definition, artificial insemination delivers sperm into the woman’s womb. In Vitro Fertilization (IVF) goes beyond this point by bringing the woman’s egg and the man’s sperm together outside the woman’s body. The term “test tube babies” is synonymous with IVF.

Since 1978, and Louise Brown’s birth (the first person born via IVF) in Great Britain, this technique has greatly surpassed its initial purpose, specifically as a means to deal with tubal infertility. Today, more than half of all IVF procedures are performed for other reasons, for example, it is used in response to unexplained infertility and to increase the success rate in cases of male infertility.

For most people, IVF is simply about two gametes being joined in a test tube. But for couples who have decided to undergo IVF treatment, it means countless clinic appointments, blood tests, injections, a lot of probing and prodding and a great deal of waiting. Waiting for test results, waiting for embryos, waiting for the pregnancy test, waiting for the arrival of a child in their life.

The many challenges that couples undergoing IVF treatment will have to meet include learning all about the process; a considerable amount of information that is not always easy to understand. We suggest that before you decide to undergo IVF treatment, you find out as much as you can on the subject by speaking with your physician and by researching the topic via the numerous books and websites dedicated to it. Learning as much as you can will help put your mind at ease as you embark upon your IVF treatment.

Preliminary Stages of IVF

You and your partner will meet with one of our physicians. At that point, you will receive your diagnosis, and work closely with your physician to determine if IVF is the best treatment option for your specific situation.

Once you have decided to pursue IVF, you will undergo the general work-up, along with further meetings, appointments and tests:

  • A consultation with a counselor or psychologist who specializes in fertility.
  • Another appointment with your physician to formulate your IVF plan.
  • A meeting with your nurse where she will review all the information relative to each stage of the treatment with you. She will also give you your medications and explain how to use them and the treatment calendar.

Instructional Videos for Medications:

At Procrea , we know that this process can be overwhelming, and we want to give you as much information as possible in order to make your journey a smooth one.

You can access videos for commonly used medications during fertility treatment.

Procrea Fertility is not  responsible for the content and information generated by these independent online resources.

  • A consultation with the urologist if you need epididymal sperm aspiration or testicular sperm extraction. A blood sample may also be required for genetic testing. Patients have the choice of having these tests performed at their Procrea Fertility practice or elsewhere.

All of these preliminary stages allow you to better prepare yourselves for IVF by correcting any identified causes and providing you with all the information you need to understand the process. The stages of the IVF process itself are explained below.

First Stage: Ovarian Suppression

The first stage of the process consists of suppressing ovarian function by administering an oral contraceptive and/or a medication that inhibits pituitary gland function. This stage is not always required and your doctor will determine if you need it or not. During the suppression phase, the levels of estrogen become very low, similar to menopause, which leads to some of the side effects, such as hot flashes and mood changes. This stage (if determined to be the best choice for you) then allows us to replace your natural cycle by an artificial cycle, which is then controlled with the medications prescribed.

Second Stage: Ovarian Stimulation (superovulation)/Controlled Ovarian Hyperstimulation (COH)

Ovarian suppression is reached when the estradiol level is sufficiently low, as described in Stage 1. At this time, ovarian stimulation can begin in order to achieve an “artificial cycle”. Your ovaries usually produce and release a single egg per cycle. Although this is sufficient for natural conception, conception with IVF usually requires more.

This is achieved by ovarian hyperstimulation. These medications stimulate the development of several ovarian follicles resulting in the retrieval of more eggs.

  • Estradiol levels – this blood test is used as an indicator of your response to the medications.
  • LH – luteinizing hormone – these levels need to be suppressed in order to block you from releasing the eggs too early.
  • Transvaginal ultrasound – used to see the number and the diameter of the follicles that have developed during ovarian stimulation.

Third Stage: Triggering the Egg Maturation Process

When follicles are large enough and when hormonal levels are adequate, it is time to trigger the ovaries to prepare the eggs for maturation and ovulation. The trigger is done by injecting hCG (human chorionic gonadotropin, a pregnancy hormone similar to LH) or a recombinant hormone.

Fourth Stage: Egg/Oocyte Retrieval (also referred to as Ovum Pickup – OPU)

Eggs are retrieved transvaginally under ultrasound guidance. Having located the mature follicles, the physician will insert a needle, attached to the probe, into each follicle and aspirate the fluid from each of them. You are given a local anesthetic and a sedative through an i.v. (intravenous) infusion. If you are interested, you may watch the procedure on the ultrasound monitor. The embryologist analyzes the contents of every follicle under the microscope. Once the procedure is completed, you are told how many eggs were retrieved. On that same day, these eggs will be combined with the sperm, In Vitro, should fertilize and then form the embryo.

Fifth Stage: Embryo Transfer

Embryo transfer entails placing one or more embryos (usually one) inside the patient’s uterine cavity usually on cycle day 5.
It requires a full bladder for better visualization with the abdominal ultrasound probe.

What’s Next?

Having to wait for your pregnancy test is often the most stressful time for patients undergoing IVF treatment. A blood test will be performed 12 days following your transfer; this test accurately detects the pregnancy hormone (hCG) in your blood. You will be called the same day with the long-awaited result, which will hopefully be positive.