Ovulation Induction with Injection
Your physician and you may elect to proceed with SOURCE. (Super Ovulation Uterine Receptivity Cycle Enhancement.)
Because of the complexity of the program, you will be interacting with a number of different team members during your cycle. The physicians rotate through the ovulation induction program a week at a time as the "IVF physician".
Therefore, you may work with physicians other than your primary SRM physician. The medical, nursing, laboratory and support staff provides seven days week coverage so you will become familiar with many members of our staff. The Ovulation Induction Program includes the possibility of four steps:
- Development of ovarian follicles (the growth and maturation of eggs using medications such as clomiphene citrate, an oral medication, and/or gonadotropins, serial self-administered injections).
- Stimulation of ovulation with hCG (Human Chorionic Gonadotropin) injection.
- Intrauterine Insemination (IUI) with a partner's or donor prepared sperm.
- Hormonal support of the luteal phase with progesterone, if recommended by you primary physician.
- Follow up blood tests and obstetrical appointments.
Standard Stimulation Cycle
Ovarian Follicular Development
You may start using injectable Human Menopausal Gonadotropins or recombinant gonadotropins on day 3 of your cycle and continue for approximately 8 to 10 days until the follicles are mature.
Gonadotropins are medications normally used to induce and stimulate ovarian follicle development so that ovulation can occur.
Gonadotropins are given as a daily injection. The medication is used to stimulate more than one follicle to develop, therefore, increasing your chance of pregnancy but also increasing your chance of a multiple pregnancy.
Ovulation drugs are not associated with increased risk of birth defects or spontaneous miscarriages. When follicles are mature (determined by ultrasound and blood estradiol levels), another medication will be given by injection, Human Chorionic Gonadotropin (hCG). hCG is like a woman's natural LH and causes the follicle(s) to release the egg(s).
Monitoring Ovarian Follicular Development
After a baseline ultrasound is performed soon after your period starts, starting on day 8 of your menstrual cycle, you will have a blood test for estradiol and a vaginal ultrasound examination. The estradiol blood levels and ultrasound are used together to assist in determining follicle maturity. Ultrasounds and blood tests will continue daily or at longer intervals until you are ready for hCG. How long you will be on these injections can vary tremendously, depending on your personal medical situation.
Human Chorionic Gonadotropin (hCG)
When ultrasounds and blood estradiol levels indicate your follicles are mature and ready to ovulate, you will receive hCG.
If inseminations are recommended for you, 1-2 inseminations will be performed 18-42 hours after hCG administration.
There are two inherent risks involved with the use of gonadotropins, namely:
- multiple pregnancies
- enlargement of the ovaries during the second half of the cycle (called hyperstimulation).
These risks are increased when too many follicles mature at once and the estrogen in the blood is too elevated. Therefore, we consider it very important to have the ultrasounds and blood levels performed.
Luteal Phase Support
If your physician has recommended luteal phase support after HCG, it will begin approximately 3-4 days after ovulation (this may be done with progesterone). You will be given written instructions on type, dosage, and when to administer the medications to supplement the luteal phase. This medication should continue until the result of the pregnancy test is known.
If pregnancy occurs, the medications will continue through the 10-12th menstrual week of pregnancy. If the pregnancy test is negative, the luteal support may be discontinued.
Follow-Up Blood Tests and Appointment
To determine the outcome of a SOURCE cycle, simply await the onset of a normal period. If abnormal or late with your expected menses, return for a blood pregnancy test 17 days after the HCG injection or check a home pregnancy test.
You may arrange a follow-up appointment with your physician after your cycle if you wish. This visit will be to summarize your Ovulation Induction cycle, discuss future plans (prenatal care, future Ovulation Induction cycles, other infertility options), and to answer questions.
Success with the Ovulation Induction Program
Successful pregnancy occurs in approximately 15-20% of cycles we perform. This statistic may vary and may be higher if you have a ovulatory dysfunction.
Because of the tremendous success we have had with IVF, SOURCE has become a less popular option.
To minimize these risks we have certain criteria above which we will recommend cancellation of the cycle. Should this occur, the hCG will not be given and abstinence encouraged.