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. It is called a ‘natural’ cycle as no medications are involved. This process provides the Fertility Specialist with dynamic information about your ovulatory function, as well as guidance for the exact timing of intercourse or intrauterine insemination (IUI).
Timed intercourse is a first line, low intervention treatment option that will allow you to increase your chances to conceive by having sexual intercourse during your ‘fertile window’, the specific time frame where you are expected to be most fertile. Often, by the time a person is referred to Anova, they have already tried at-home ovulation testing, and/or basal body temperature tracking to time their intercourse.
More information about Cycle Monitoring at our clinic
With the COVID-19 pandemic, we have implemented additional protocols and processes to ensure a visit to the clinic is as low risk as possible. This means that all visits require an appointment, and you can request an appointment here
The cycle monitoring hours are:
Monday – Friday: 7:00 am to 9:30 am; Saturday (if instructed): 7:00 am to 9:00 am Holiday hours vary
Some points to remember about cycle monitoring:
- Some time slots for cycle monitoring are more popular than others. We may not always be able to o offer the same time slot to patients when planning their next visit to the Clinic.
- Cycle Monitoring is a meant to be a quick check-in so patients can come and go as quickly as possible, and will receive further instructions later in the day if needed. If you have a question or concern that needs some time to discuss, please either book an appointment to talk to a nurse or your doctor.
- Your clinical team will review the results and give you detailed instructions later in the day, usually by 4:00 pm.
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, or may be used as part of an egg retrieval cycle. 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 how your body responds to the medications, which is tracked through ultrasounds and blood work, the doctor will adjust the dose of the medications. Timing is important, whether you are using ovulation induction as part of a timed intercourse cycle, IUI, or IVF.
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. 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. Generally, it is prescribed for five days, and taken during the early part of the menstrual cycle, but at Anova our fertility protocols are tailored to each individual person.
Risks using Clomiphene Citrate
As with all medication, there can be side effects to taking clomiphene including: headaches, nausea, hot flashes, blurry vision, and mood swings. For a detailed description, please refer to the information provided with the medication.
Some patients taking the drug may develop a thin endometrial lining that can only be detected with ultrasound, which may make it more difficult to become pregnant.
When using clomiphene without complete clinical monitoring, or without following the fertility plan, multiple gestation (usually twins) may also occur.
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 medications are produced with varying combinations of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), or as single purified agents. These medications are also referred to as gonadotrophins.
As part of natural processes, 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 create.
The patient on their own will inject these medications, and the clinic will support you with training and resource videos. Usually, they are injected into the lower abdomen or thigh, often beginning on the second or third day of your menstrual cycle. The daily injections are continued until thei developing eggs are mature and ready to ovulate, which we track through cycle monitoring visits.
The FSH preparations available at our clinic include: Puregon, Gonal-F, Repronex, Menopur
When FSH injections are combined with IUI, women with otherwise unexplained infertility who take FSH may increase their pregnancy rate per cycle by up to 18%.
This rate may be less in women who are 38 years or older.
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.
Risks of using FSH:
- Pain and Inflammation – Pain and/or swelling at the injection site is common. Many patients find relief by applying ice to the area. Relatively few patients also experience bruising or welts around the injection site.
- Multiple Pregnancy – One of the major risks of using FSH medication is multiple pregnancy, or becoming pregnant with more than one child (twins). 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 may develop 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 final 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 may accumulate internally.
There are two common misconceptions about these medications:
- 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.
How to administer the medication:
There are many useful videos and resources for patients who will need to prepare and administer different fertility medications.
Where can you get more information?
The nursing team will review with you how to properly administer your medications from home. We also have learning videos available through our education modules.
From the medication manufacturer
The major pharmaceutical brands have very detailed videos available in multiple languages. You will require the drug identification number (DIN) on the side of the medication to log in:
you can also speak to a Nurse 24/7 if you have medication related questions
From different pharmacies
Freedom MedTeach, available here