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Assisted Reproductive Technology (ART) refers to the scientific methods that are used to unite sperm and eggs. The most common ART procedures include In Vitro Fertilisation (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI).
Recent estimates show that about 3% of all women who give birth in Australia receive some form of ART treatment.
In Vitro Fertilisation (IVF) involves placing an egg and sperm together to fertilise in a laboratory. Once fertilisation takes place, the embryo is transferred to the uterus to hopefully implant and become a pregnancy.
Intra-Cytoplasmic Sperm Injection (ICSI) is a laboratory technique used when successful fertilisation of the egg cannot be achieved with standard IVF. While IVF allows the sperm to penetrate the egg of its own accord, in ICSI a single sperm is directly inserted into the egg.
Intrauterine insemination (IUI) involves placing specially prepared semen into the woman’s uterus. Sperm is usually provided by the woman’s partner. IUI is offered when:
IUI is not used when there is a decreased number of sperm or decreased sperm motility. However, it may be useful when apparently normal sperm are unable to move through the cervix.
Ovulation is the process of an egg being released from one of the ovaries. This usually happens once every month in women between the ages of 13 and 50 years, except when she is pregnant or taking the oral contraceptive pill.
In some women, ovulation does not occur regularly. Ovulation may occur once every 6 to 8 weeks; once every few months, once or twice a year, or perhaps never unless they are given treatment to stimulate the ovaries. It is also quite common for women who have regular periods to have 1 or 2 cycles a year in which they do not ovulate but they still have a period or bleeding around the expected time.
What is Ovulation Induction (OI)?
The term ‘Ovulation Induction’ (OI) is used to describe the process of stimulating the ovary to produce a mature egg (oocyte) and causing the release of the egg (ovulation). If sexual intercourse occurs at this time and the egg is fertilised by the sperm then a pregnancy may occur.
The common medications used to induce ovulation can be in the form of oral or injectable medications.
• Clomiphene Citrate (Clomid, Serophene) and Letrozole (Fenara) are oral medications used for 5 days in the early stage of the menstrual cycle. The dose may vary depending on previous response.
• Metformin (Diabex, Diaformin) is an oral medication, which may be used to help control insulin resistance or impaired glucose tolerance in women. This can be a common finding in women with irregular cycles due to Polycystic Ovarian Syndrome (PCOS).
• Gonadotrophic injections (Gonal F, Puregon, Menopur) are given by subcutaneous injection into the lower abdomen. Either medication can be used on a daily basis or until a mature follicle or follicles are seen by ultrasound monitoring. Due to the increased risk of multiple pregnancy this treatment will require frequent monitoring by hormone levels and ultrasounds. Once the chance of a multiple pregnancy has been excluded, ovulation will be caused by an injection of another gonadotrophin (Pregnyl, Ovidrel).
Ovulation Induction with Intrauterine Insemination (OI-IUI) combines stimulation of ovulation (using a low dose of an injectable fertility hormone) with insemination of the partner’s fresh or frozen sperm into the uterus. The use of the fertility hormone helps to ensure complete growth of the egg. Release of the egg (ovulation) can also be controlled more precisely to coincide with the time of insemination.
The procedure offers a useful and less invasive alternative to In Vitro Fertilization (IVF). However, it is only useful for couples where the subfertility is unexplained or where there is mild endometriosis. This treatment is not appropriate when there is damage to the fallopian tubes or when there are abnormalities in the sperm. In these circumstances, treatment with IVF or ICSI is a much more effective option.
Ovulation Induction (OI) process
A low dose of a fertility hormone is given by injection starting on cycle days 4-6. This hormone (called Gonal-F or Puregon) is a highly purified form of the naturally occurring female hormone called Follicle Stimulating Hormone (FSH). There are no artificial chemicals or compounds in the injection so the only expected side-effects are those that result from an over-sensitivity to the natural effects of the female hormone. Daily injections are usually required for 6–10 days. The injections are given under the skin of the abdomen once a day. To reduce the number of times you need to visit Westmead Fertility Centre (WFC), we will show you how to give the injections to yourself.
Your response to the fertility drugs is closely monitored by blood tests and ultrasound scans. Your first blood test will be performed on the day you start your injections, this is called a ‘baseline’ blood test to check that your period is normal. Normally, we do not call you with these results. Thereafter you will need to have a blood test on the 5th or 6th day of your injections and then every 2 or 3 days until your hormone level starts to rise. You will be contacted with each blood test to inform you of the results. The number of blood tests required varies between women and even from one cycle to another in the same woman.
This hormone oestrogen indicates an egg follicle is starting to grow. When your oestrogen level suggests the egg follicle could be mature, you will be asked to come to Westmead Fertility Centre for an ultrasound scan. When the ultrasound scan shows that one follicle (the bag of fluid surrounding an egg) in the ovary has grown to at least 17mm the egg is considered to be mature and ready to be released (ovulated). An injection of a second female hormone called HCG (or natural pregnancy hormone) is then used to trigger ovulation. This injection of Ovidrel takes approximately 36 hours to trigger the release of the egg. The insemination is performed approximately 24–36 hours after this injection to ensure that there are adequate numbers of sperm in the woman’s body at the time of egg release.
Your fertility specialist will determine the right course of treatment for you. Many couples require minimal intervention to achieve a pregnancy, while others need to undergo procedures, such as IVF or ICSI.