Ovulation Induction Clomiphene citrate (Clomid
) is commonly used to start the ovaries ovulating again. It is taken on days 2-6 of a cycle and it kick-starts the ovary into making and releasing an egg. A day 21 progesterone level in the first cycle will check that it has worked, but some women need a higher dose. It is a safe drug but, as with most ovulation treatments, it increases the risk of a multiple pregnancy, such as twins. This happens in about 1 in 20 women treated with clomiphene.
Ovarian drilling is a treatment that is used in PCOS where clomiphene is unsuccessful. Several small holes are made in the ovary during a laparoscopy, and this reverses the hormone problems associated with the disease. The success rate depends on many factors, but typically around 50% of women fall pregnant within 1-2 years of treatment and by 3 years about 75% are successful.
This type of ovarian stimulation is a more intensive treatment than Clomid, and uses injections of hormones on a daily basis and close ultrasound monitoring of the ovarys response. The aim is to produce several good quality eggs and time their release with intercourse. Side effects include multiple pregnancy (10-20%), an increased risk of ectopic pregnancy and a condition called ovarian hyperstimulation syndrome, where an unexpectedly excessive response occurs and large ovarian cysts develop. The success rates vary greatly depending on the individual situation, but 40-85% after 6 treatment cycles is typical. Success after 6 cycles is less likely, though not impossible, and IVF is usually advised if this is unsuccessful.
Intrauterine Insemination (IUI)
This involves injecting a sperm sample through a soft tube though the cervix into the cavity of the uterus. It is often combined with superovulation and is then caled superovulated IUI.
In Vitro Fertilisation (IVF)
IVF (In vitro fertilisation) involves a stimulation cycle with ultrasound monitoring, similar to that described above.
The eggs are retrieved, usually by ultrasound-guidance and conception takes place in the laboratory. About 72-80 hours later the embryos are replaced into the uterus, through the cervix.
The success of IVF depends very much upon the age of the woman and the duration of infertility so far, but average success rates of 16-25% per cycle are usual.
Side effects are similar to those of ovarian stimulation and the risk of multiple pregnancies depends upon the number of embryos replaced.
Intra Cytoplasmic Sperm Injection (ICSI)
This is similar to IVF but in ICSI a single sperm is selected and injected into the egg to fertilise it.