Cycle Monitoring & Ovulation Induction

At Anova Fertility, natural cycle monitoring is generally the initial stage in a patient’s fertility care. It involves a patient coming to our clinic in the early morning to have a transvaginal ultrasound and blood work drawn on several mornings during a 2 – 3 week period of time. The test results are used to map out your menstrual cycle. This process provides the Fertilty Specialist with dynamic information about your ovulatory function, and it also allows for the exact timing of intercourse or intrauterine insemination.

Once you have ovulated, you will return to the clinic for a pregnancy test.

More information about Cycle Monitoring at our clinic

The cycle monitoring hours are:

Monday – Friday: from 7:00 am to 9:30 am; Saturday and Sunday (if instructed): from 7:00 am to 9:00 am

Holiday hours vary, please check postings or call for times at 416-225-4440.

Some points to remember about cycle monitoring:

  • As we are a group practice, you may not see your own doctor at every cycle monitoring visit.
  • The doctor covering will review with you that day's ultrasound results, and give you instructions for the next day to return to the Clinic. Your own doctor will review the results of your blood tests taken that morning and a nurse will call you with more specific instructions or changes as a result.
  • Nurses will call patients with instructions by 4:00pm the same day (unless we have had any technical difficulties with equipment). Please call the nurse line if you do not hear from a nurse by then.
  • Some time slots for cycle monitoring are more popular than others so we are not always able to offer the same time slot to patients when planning their next visit to the Clinic.
  • Cycle Monitoring is a quick check-in so patients can come and go as quickly as possible. If you have a question or concern that needs some time to discuss, please either book an appointment to talk to your own doctor or call one of our nurses about those concerns.  

Ovulation Induction

A normal menstrual cycle usually only produces one mature follicle that results in the ovulation of a single oocyte or egg. Ovulation induction is a procedure that uses medication to increase the number of eggs ovulated per cycle, which may improve the chances of pregnancy. Every patient taking these medications will be monitored closely (during the clinic’s cycle monitoring hours) over a 2 – 3 week period of time, via ultrasounds and blood tests, to determine their response to the treatment. Based on the results of the patient’s ultrasounds and blood work, the doctor will adjust the dose of the medications as necessary and inform the patient as to the optimal time for intercourse or intrauterine insemination.

 

Medications

Clomiphene Citrate

Clomiphene Citrate is often used as a first option for ovulation induction. Clomiphene is given in pill form to women who do not ovulate regularly, as well as those who ovulate regularly but wish to have more than one egg mature each month. Generally, it is prescribed for five days, and taken during the early part of the menstrual cycle. This medication causes the release of more follicle stimulating hormone (FSH) by stimulating the pituitary gland. Ideally, the increased levels of FSH in the body will result in the maturation of a follicle or follicles and eventually lead to ovulation.

As with all medication, there can be side effects to taking clomiphene including: Headaches, Nausea, Hot flashes, Blurry vision, Mood swings

Other risks

Some patients taking the drug may develop of a thin endometrial lining that can only be detected with ultrasound, which may make it more difficult to become pregnant.

Multiple gestation (usually twins) occurs in approximately 8-10% of patients taking clomiphene.

Injectable Gonadotrophins (FSH)

Injectable gonadotropins are another group of fertility drugs often prescribed for ovulation induction. These medications directly stimulate the ovaries to increase the number of developing follicles. The drugs are produced with varying combinations of Follicle-stimulating hormone (FSH) and/or Luteinizing hormone (LH) or as single purified agents. Patients administer the drug on their own by injection (usually in the lower abdomen or thigh), beginning on the second or third day of their menstrual cycle. The daily injections are continued until their developing eggs are mature and ready to ovulate.

FSH travels from the brain to the ovaries to promote egg development. The FSH given to patients via injection provides much higher concentrations than the brain would naturally. The FSH preparations available at our clinic include:

Puregon, Gonal-F, Repronex, Menopur

Risks of Using FSH

Multiple Pregnancy

One of the major risks of using FSH is multiple pregnancy. Multiple pregnancy occurs in 20-30% of patients taking the drug, and the majority of these are twins. Triplets and quadruplets occur in less than 1% of pregnancies. Based on the number of developing eggs seen on ultrasound, the doctor will advise a patient of her risk. In cases where too many eggs develop at once and the risk of multiple pregnancy is too high, the patient may be instructed to stop taking FSH and to avoid having intercourse.

Ovarian Hyperstimulation Syndrome (OHSS)

Patients taking gonadotropins also run the risk of developing ovarian hyperstimulation syndrome (OHSS). This condition occurs when too many eggs develop at once and the hormone levels in the blood become too high. In some cases, usually when the HCG injection is given, OHSS can happen after the eggs have ovulated. If the doctor believes a patient is at risk of developing OHSS, she will be advised to adjust or reduce the dose of gonadotropins being taken. This will slow the development of the condition and/or prevent it from worsening. For most women who develop this condition, the symptoms resolve on their own over time. If the hyperstimulation is severe, the patient may require other procedures, such as: close monitoring, blood work, and the drainage of the excess fluid that accumulates internally.

Pain and Inflammation

Pain and/or swelling at the injection site are also common. Many patients relieve their discomfort by applying ice to the area. Relatively few patients also experience bruising or welts around the injection site.

For Your Information

The risk of birth defects is not higher in women taking FSH.

FSH injections do not increase a woman’s chance of developing ovarian or other types of cancer.

When FSH injections are combined with IUI, women taking FSH (with otherwise unexplained infertility) may have pregnancy rates of up to 18% per cycle. Please note: This rate may be less in women who are 38+.

Women taking FSH because they are unable to produce eggs on their own (polycystic ovary syndrome), may have higher rates of pregnancy – approximately 20-30% per cycle.