Download information on ovulation induction

Patient Information
Obstetrics and Gynaecology Services
INFORMATION ON OVULATION INDUCTION
Introduction
Usually each month one ovary will be stimulated by hormones produced in the brain.
These cause a small cyst or follicle to grow on the ovary in which an egg develops.
Another hormone then causes the follicle to release one egg to travel down the fallopian
tube where it can be fertilised by the sperm which swims up from the vagina.
This usually occurs around 14 days after the beginning of a period, but can vary between
11 – 16 days.
In up to a third of women (25%-30%) who have not conceived after a year’s unprotected
intercourse, the problem is due to the ovaries not producing an egg.
Polycystic Ovarian Syndrome (P.C.O.S.) is the commonest cause. Other common causes
of failure to ovulate are stress and weight loss or gain.
In some cases failure of ovulation is due to the ovary not working properly. This may occur
following treatment for cancer or may be the start of an early menopause.
What can I do as the patient?
If you are overweight and your BMI >30, the initial treatment is to lose weight.
Reduction of weight leads to spontaneous ovulation. The long term benefits of weight loss
are a decreased risk of diabetes (increased sugar levels in your body) and heart disease.
You can be referred to a dietician if you choose to.
Any other health advice to follow while we try for a child?

Ideally you and your partner should refrain from smoking.

You should be taking folic acid tablets.

The alcohol intake should be limited to 1-2 units per week for you and 3-4 units per
week for your partner.

This should be incorporated into a healthy diet and lifestyle.

You can self refer or we can refer you to the free Central Essex Health Trainer
Service. Leaflets for this are available. Please ask the nurse about this service.
Patient Information
What is Clomifene?
Clomifene (also known as Clomid) is an ovulation induction tablet, taken for 5 days at the
beginning of the cycle (usually on days 2 to 6, with day 1 being the first day of bleeding in
a period).
How do the tablets work?
They work mainly by increasing the amount of stimulating hormone which is released from
the brain leading to the egg being produced from the ovary.
What do I do if my periods are infrequent?

Do a pregnancy test if you have not had a period for 40-45 days.

If the pregnancy test is negative you will be given a tablet (Provera) to take twice a
day for 5 days.

The period happens after 5 to 10 days of stopping Provera.

You can then start taking Clomifene from the second day of the induced period.
How do I know that Clomifene is working?
This is done by a blood test after the 21st day of the menstrual cycle.
Please phone the Fertility Nurse Specialist on: 01245 513072 / 01245 513552,
approximately two days after the blood test for your results.
What are the side effects of taking Clomifene?
These drugs are generally very safe, and have been in use for the last 50 years.
Some people do notice some side-effects, which can include hot flushes, abdominal
discomfort, nausea, breast tenderness, hair loss, or insomnia. However the only serious
concern, which is very rare and reversible, is visual disturbance such as blurred eyesight,
in which case the treatment should be stopped immediately.
The maximum time that Clomifene can be taken each cycle is up to a year.
The main issue to consider with these drugs is it increases the likelihood of multiple
pregnancies.
The likelihood of having twins is about 1 in 10, compared to 1 in 80 without treatment.
The likelihood of triplets or greater is very small, less than 1 in 5000, but is nevertheless
increased.
Patient Information
Success rates
The success rate will vary depending on your age, cause of infertility and response to
treatment. About 80 % of women who take Clomifene will have success in producing an
egg. This, of course, does not guarantee they will have a successful conception.
The chance of conceiving in the first month of taking Clomifene is 30% however of those
women who successfully ovulate as a result of taking Clomifene, around 40 to 45% of
couples will have a successful conception within six months of treatment.
Hence you may need more than 1 cycle of treatment and this increases your chance of
success.
What are the other treatments for women with PCOS?
Women with PCOS, who are not ovulating, are normally given Clomifene as first line
treatment and usually respond very well to this.
Two alternatives are available:
Metformin - These medications were initially designed and approved for the management
of type 2 diabetes, where they work by improving the body’s sensitivity to insulin a
hormone which controls your sugar levels.
Although most women with PCOS will ovulate with Clomiphene, many are resistant, and
may require an alternative treatment.
When used alone for four to six months, insulin sensitizing agents such as Metformin can
restore regular ovulation and periods in some women with PCOS.
Often it is used in conjunction with ovulation inducing agents.
Ovarian drilling - This is a surgical treatment that requires a laparoscopy (see leaflet) to
be carried out.
Cysts are punctured with a fine needle to try to reduce the number of small cysts on the
surface of the ovary. This may trigger natural ovulation to occur in about 60% of patients
with PCOS but is usually beneficial during the first 6-9 months following the procedure.
This is an invasive procedure which carries the associated risks of laparoscopy.
It may also cause scar tissue to form in the area of the ovary.
Patient Information
Contacts / Further Information
If you would like further information, regarding the evidence printed in this leaflet please
refer to: www.hfea.gov.uk or http://guidance.nice.org.uk/CG11
Please ask if you require this information in other languages, large print, easy read
accessible information, audio/visual, signing, pictorial and change picture bank forma via
the Patient Advisory Liaison Service (PALS) on (01245) 514235.
Mid Essex Hospital services NHS Trust is smoke-free. You cannot smoke on site.
For advice on quitting, contact your GP or the NHS smoking helpline free, 0800
169 0 169
Charitable donations can make a very real difference to the level of patient care at our
Trust. As well as contributing to new facilities, donations can be used to buy specialist
equipment and smaller items to make patient’s stay in hospital more comfortable. For
information about making a donation please contact the Charities Office on 01245 514559
or visit the website at: http://www.meht.nhs.uk/get-involved/
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Obstetrics and Gynaecology Services
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Information on ovulation induction
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