Ovulation induction and intrauterine insemination (IUI)

Overview of simpler fertility treatments
Not all fertility challenges require IVF. In some cases, less complex approaches that work with your natural cycle may be effective.

These include:

• Tracking ovulation timing

• Using medication to stimulate ovulation

• Intrauterine insemination (IUI)

• A combination of ovulation induction and IUI

Tracking ovulation

Identifying when ovulation occurs can be challenging. At home, this is often done using ovulation predictor kits, which detect a rise in luteinising hormone (LH) in the urine. This surge usually happens about a day before ovulation and signals the most fertile time for intercourse.

In a typical 28-day cycle, ovulation often occurs around day 14, although normal cycles can range from 25 to 35 days.

Monitoring can also be performed in the clinic using transvaginal ultrasound to track follicle growth. By measuring follicle size, clinicians can estimate when ovulation is likely to occur.

Ovulation induction with medication

If ovulation is irregular or not occurring, medication may be used to stimulate the ovaries.

Tablets:

Oral medications are commonly taken for about five days early in the cycle and aim to promote the development of one or two follicles.

These are generally well tolerated, though some people may notice mood changes or hot flushes. Any visual symptoms should be reported to your doctor.

Injections:

Hormonal injections (containing follicle stimulating hormone, or FSH) may be used in low doses to encourage the development of one or two eggs.

These are usually self-administered daily under the skin of the abdomen.

Possible side effects include fatigue, headaches, mood changes, mild fluid retention, and nausea.

Monitoring and timing ovulation

Ultrasound scans, along with blood or urine tests, may be used to determine the best timing for ovulation. In some cases, an injection of hCG (a “trigger” injection) is given to induce ovulation. This may cause temporary symptoms such as abdominal discomfort or breast tenderness.

Progesterone may also be prescribed after ovulation to support the uterine lining. Some individuals experience side effects such as bloating, nausea, headaches, or breast sensitivity. Very rarely, serious complications like blood clots can occur.

Risk of multiple pregnancy

If too many follicles develop, your doctor may advise to cancel the cycle and avoid unprotected intercourse to reduce the risk of multiple pregnancy.

Even with precautions, multiple pregnancies can still occasionally occur. This may happen if sperm were already present before cancellation or if some follicles were not visible on ultrasound.

·         Twin pregnancy risk with tablets: approximately 2–3%

·         Twin pregnancy risk with injections: approximately 5–10%

Triplets or more are rare but carry significant risks and are generally avoided

Multiple pregnancies are associated with increased risks including,

·         miscarriage,

·         premature birth,

·         high blood pressure (preeclampsia),

·         gestational diabetes,

·         placental complications,

·         low birth weight,

·         caesarean delivery,

·         complications related to prematurity such as cerebral palsy.

Intrauterine insemination (IUI)

IUI is a procedure where sperm is prepared in the laboratory to concentrate the healthiest sperm before being placed directly into the uterus. This can be done in a natural cycle or alongside ovulation induction.

During the procedure, a speculum is used to visualise the cervix. A fine catheter is then passed through the cervix into the uterus, and the prepared sperm sample is gently introduced.

After the procedure, mild cramping or light spotting can occur. Most people can return to their normal daily activities straight away.