Ovulate From Trigger Shot Then Again Naturall

I NTRODUCTION

Some women may have difficulty getting significant considering their ovaries do not release (ovulate) eggs. Fertility specialists may use medications that work on ovulation to assist these women get meaning. In that location are ii mutual ways these medicines are used: 1) to cause ovulation in a woman who does non ovulate regularly, and 2) to cause multiple eggs to develop and be released at one time.

About 25% of infertile women have bug with ovulation. These women may ovulate less frequently or not at all (anovulation). Ovulation inducation medications can assist a woman to ovulate more regularly, increasing her chance of getting pregnant. These medicines, sometimes called "fertility drugs," may besides improve the lining of the womb or uterus (endometrium).

In some situations, these medicines may be used to cause multiple eggs to develop at in one case. This is unremarkably desired when women undergo treatment known as superovulation with intrauterine insemination (IUI), in vitro fertilization (IVF), donate their eggs, or freeze their eggs (either equally eggs or fertilized eggs [embryos]).

This booklet explains the basics of normal ovulation and the diagnosis and treatment of ovulatory problems. The specific uses for several types of ovulation medicines are outlined, along with the intended results and possible side effects of each drug.

Normal Reproductive Anatomy

The ovaries are two small organs, each about 1½ inches long and 3/iv of an inch wide, located in a woman'due south pelvis (Figure 1). The ovaries are attached to both sides of the uterus (womb), commonly below the fallopian tubes. At birth, a female has about 1-two 1000000 pre-formed eggs in her 2 ovaries. Different men, who make sperm throughout their life, women are born with all the eggs they volition always accept. Near of the eggs dice off naturally (simply as hair and skin cells dice off) with normal aging. By the fourth dimension a girl reaches puberty (around age 10-xiii, on average), she has almost 400,000 eggs remaining. Equally a girl begins to have regular menstrual periods, approximately in one case a month, an egg matures within a follicle (a fluid-filled cyst in the ovary that contains the egg). When hormone levels reach the correct level, the egg is released from the follicle (ovulated). The fimbriae (finger-like projections) of the fallopian tubes sweep over the ovary and move the released egg into the tube. If sperm are present, the egg is usually fertilized in the tube. The fertilized egg (now called an embryo) begins to dissever and travels through the tube and into the uterus where information technology implants in the endometrium (uterine lining).

THE MENSTRUAL Cycle

The menstrual cycle is divided into three phases: the follicular phase, the ovulatory phase, and the luteal phase (Figure 2).

The Follicular Stage

The follicular phase lasts about 10 to 14 days, beginning with the first day of menstruum and lasting until the luteinizing hormone (LH) surge. During the follicular phase, the hypothalamus (an organ located only above the pituitary gland in the brain) releases gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to release follicle-stimulating hormone (FSH), which travels through the blood to the ovary. Each month, the brain causes the release of FSH to stimulate the development of a number of follicles in the ovaries, each containing a single egg. Ordinarily, only 1 volition go the ascendant follicle with its egg reaching total maturity; the rest of the follicles will end developing and their eggs will dice off (called atresia). The ascendant follicle increases in size and releases a hormone chosen estradiol into the bloodstream. The rising levels of estradiol cause the pituitary to irksome downward the production of FSH. Estradiol too begins to set the uterine lining (endometrium) for the possibility of pregnancy.

The Ovulatory Stage

The ovulatory phase begins with the LH surge and ends with ovulation (release of the egg from the dominant ovarian follicle). Equally ovulation approaches, estrodiol levels rising and trigger the pituitary gland to release a surge of LH. Virtually 32 to forty hours after the onset of this LH surge, ovulation occurs.

The Luteal Phase

The luteal phase begins after ovulation and generally lasts most 12 to 16 days. After the egg is released, the at present-empty follicle that had contained the ovulated egg becomes known every bit the corpus luteum. The corpus luteum produces a hormone called progesterone that helps prepare the uterine lining for implantation of the embryo and pregnancy. Afterward the egg is released it is picked upwards by the fallopian tube where fertilization occurs. If the egg is fertilized by a sperm, the embryo is transported within the tube and reaches

Figure 2.

Hormonal cycle in women with normal ovulation. The follicular stage is the stage in which the follicle is growing and secreting estrogen. The ovulatory phase is the 48-hour period characterized past the LH surge and the release of the egg (ovulation). The luteal stage is characterized past secretion of big amounts of progesterone and estrogen.

the uterus 4-5 days later ovulation. Once in the uterus, it begins to attach to the endometrium (lining of the uterus), a process that is chosen implantation. Nigh 11-13 days after ovulation, if there is no implantation, ovarian production of progesterone and estradiol starts to fall off. This causes the endometrium to break down and kickoff to shed, resulting in menstruation, also known equally the menstrual period. Every bit menstruum starts, a new ovarian cycle starts with at present increasing levels of FSH from the pituitary stimulating the growth of another group of ovarian follicles.

DIAGNOSIS

A woman who has regular periods every calendar month is probably also ovulating each calendar month with ovulation occurring about fourteen days before the first mean solar day of each menstrual catamenia. However, it is important to retrieve that a woman can accept uterine haemorrhage fifty-fifty though she never ovulates. At that place are several ways to discover ovulation, including dwelling house ovulation prediction kits that measure the LH surge before ovulation really occurs. Basal body temperature (BBT) charts tin can track the rise in temperature that follows ovulation. Other tests include measuring luteal-phase blood progesterone levels, ultrasound monitoring of ovarian follicles.

Treatment: OVULATION MEDICATION

Who Needs Ovulation Medication?

Women with irregular menstrual (oligo-ovulatory) cycles or no menstrual periods (amenorrhea or anovulation) are likely to take ovulatory dysfunction. In these women, medications tin can be used to cause regular ovulation. Earlier medicines are given, the dr. should endeavour to determine the cause of the problem with ovulation. Some possible reasons for ovulation problems include polycystic ovary syndrome (PCOS), low product of LH and FSH by the pituitary, ovaries that exercise non respond to normal levels of LH and FSH, thyroid disease, increased levels of the hormone prolactin (hyperprolactinemia), obesity, eating disorders, or farthermost weight loss and/or exercise. Sometimes the crusade cannot be identified for certain. Women with ovulatory dysfunction typically do good from ovulation consecration with fertility drugs.

Ovulation induction with fertility drugs is also used in patients without ovulatory dysfunction. The goal is to stimulate the ovaries to produce more than one follicle per cycle leading to the release of multiple eggs in the hope that at least i egg will be fertilized and event in a pregnancy. This is chosen controlled ovarian stimulation (COS), or superovulation, and may be accomplished with medicines taken by mouth or by injection. COS combined with either timed intercourse or intrauterine insemination (IUI) is commonly used as an initial treatment for several types of infertility when the woman has open fallopian tubes. COS is besides an important role of almost IVF treatment.

Before using fertility drugs for COS, information technology is recommended to make sure the fallopian tubes are unblocked and open. This can be confirmed past injecting dye into the fallopian tubes hysterosalpingogram [HSG]) or using a lighted telescope to look within the lower belly (laparoscopy). For more information on HSG and laparoscopy, please see the ASRM fact sheets titled, Hysterosalpingogram and the booklet titled, Laparoscopy and hysteroscopy. Patients with blocked fallopian tubes will not go pregnant with fertility drugs or may exist at take chances for an ectopic pregnancy (pregnancy outside the uterus). Patients with blocked fallopian tubes should not undergo ovulation induction unless the purpose of the ovulation induction is to collect the eggs in preparation for IVF.

Before starting ovulation induction, the male partner should have a semen analysis to aid decide whether ovulation consecration should be combined with timed intercourse, IUI, or IVF. For more data on IVF, consult the ASRM patient information booklet titled, Assisted Reproductive Technologies.

Usually PRESCRIBED MEDICATIONS

The most commonly prescribed ovulation drugs are clomiphene citrate (CC), aromatase inhibitors (such as letrozole), and gonadotropins (FSH, LH, man menopausal gonadotropin (hMG), chorionic gonadotropin (hCG)). Other medicines used in ovulation induction include bromocriptine, cabergoline, GnRH, GnRH analogs, and insulin-sensitizing agents, which have very specialized applications which are described below. Table 1 provides a summary of common ovulation drugs and their side effects (next page).

Clomiphene Citrate (CC)

Clomiphene is the well-nigh commonly prescribed ovulation-induction drug used to stimulate ovulation in women with infrequent ovulation or amenorrhea. Information technology also is used to induce more than than one follicle to develop in conjunction with IUI every bit a treatment for unexplained infertility and for those who are unable or unwilling to pursue more aggressive therapies.

The standard dosage of CC is 50-100 milligrams (mg) of clomiphene per day for five consecutive days. Handling begins early on in the cycle, usually starting on the second to 5th day after flow begins although it can too be started without a period if the woman is anovulatory. If a woman does not have periods, a period can be induced past taking an oral progestin for five-12 days.

Table 1. Ovulation drugs and their about common side upshot

Clomiphene works by causing the pituitary gland to make more FSH. The higher level of FSH stimulates 1 or more follicles to develop (each containing a single egg). As the follicles grow, they secrete estradiol into the bloodstream. Almost a calendar week after the final dose of CC is taken, the college levels of estradiol cause the pituitary to release an LH surge. The LH surge causes the egg(due south) in the dominant follicle(s) to be released. Information technology is important to determine whether the dose of CC given results in ovulation. This tin can be done using the menstrual blueprint, ovulation prediction kits, measurement of claret progesterone levels, or the basal torso temperature chart to monitor a patient'due south response to the given dose of clomiphene.

If ovulation does not occur at the fifty-mg dose, CC is increased by 50-mg increments in immediate or subsequent cycles until ovulation happens. More than 200 mg each day for five days is ordinarily not helpful, and women who practice not ovulate on a clomiphene dosage of 200 mg tend to respond better to a different handling, such as injections of gonadotropins. Your medico volition determine the advisable dose for you. Occasionally, the doctor may choose to add other medicines to a CC regimen if the drug does not induce ovulation. For more data about detecting when ovulation has happened, refer to the ASRM Patient Fact Sheet titled, Ovulation Detection.

Depending on the timing of the menstrual bike compared with the time of ovulation, the cervical mucus can either help sperm enter the uterus or act as a barrier. Under the influence of estrogen before ovulation, the mucus is thin and stretchy which helps sperm. In the days following ovulation, when progesterone levels ascent, the mucus becomes thick and tenacious. In some women, CC can alter cervical mucus, making it thicker. IUI tin can exist used along with CC to help overcome this. CC sometimes can modify thickness of the uterine lining, making information technology thin and less receptive to implantation. For this reason, the lowest dose of CC that causes ovulation in anovulatory women is usually prescribed. CC will induce ovulation in about 80% of properly selected patients. In one case the CC dose that induces ovulation is established, 3 ovulatory CC cycles are an adequate trial for near patients and may be continued for upwardly to six cycles. However, studies show that CC should not exist given for more than six cycles, because the chance of pregnancy is very low and culling treatments should be considered.

CC is by and large not effective for women who accept irregular or absent ovulation due to disorders of the hypothalamus (such equally those associated with severe weight loss) or very low estrogen levels (such as those with non-functioning ovaries). In improver, women who are obese may have ameliorate success later weight loss. CC is generally tolerated well. Side effects are relatively mutual, merely by and large mild. Hot flashes occur in nigh 10% of women taking clomiphene, and typically disappear soon after the final pill is taken. Mood swings, chest tenderness, and nausea also are common. Severe headaches or visual problems (such as blurred or double vision) are uncommon and most always reversible. In the event that these astringent side furnishings occur, treatment should be stopped immediately and the patient should inform her doc. It is not advisable to reattempt any further exposure to CC in these cases.

Women who excogitate using CC accept approximately a 5-8% chance of having twins. Triplet and higher-lodge pregnancies are rare (<1%), but may occur. Ovarian cysts, which can crusade discomfort, may grade but typically resolve with time. A pelvic test or ultrasound may be done if indicated to look for ovarian cysts earlier showtime some other CC handling bike. Side furnishings are more frequent with higher doses.

Aromatase Inhibitors

Aromatase inhibitors are medicines that temporarily decrease estradiol levels, which crusade the pituitary gland to make more FSH. Two medicines, letrozole and anastrozole, are currently FDA-canonical to treat chest cancer that occurs after menopause, but have likewise been used to induce ovulation in women with ovulatory problems. Handling begins early in the cycle, usually starting on the second to fifth day after menstruation begins although it also can be started without a menses if the woman is anovulatory. The typical dose is ii.five–5 mg daily for v days. Studies show that pregnancy rates with aromatase inhibitors are similar to CC rates, and may be meliorate in certain ovulation disorders such as polycystic ovary syndrome (PCOS). Like to CC, it can be used to cause more than one follicle to develop for fertility treatments with superovulation-IUI, with like success rates with CC combined with IUI. Recent research has not shown whatsoever increased risk for birth defects in children whose mothers took letrozole for fertility treatment.

Insulin Sensitizing Drugs

Insulin resistance and the associated loftier levels of insulin in the blood (hyperinsulinemia) are seen commonly in women with polycystic ovary syndrome (PCOS). Although about women with PCOS will ovulate with clomiphene, some will non ("clomiphene resistant") and ultimately require an alternating or boosted treatment. When used by themselves for 4–vi months, insulin-sensitizing agents such equally metformin can cause regular menstrual periods and ovulation in some women with PCOS. Insulin-sensitizing agents are not currently approved by the FDA for this purpose; they are approved to treat type 2 diabetes by improving the trunk'due south sensitivity to insulin. 11

Some PCOS patients do not ovulate in response to either CC or metformin alone merely may reply when the 2 drugs are used together. In a large study sponsored by the National Plant of Child Wellness and Man Development (NICHD), metformin alone helped fewer couples conceive than CC past itself, or metformin and CC combined. This is in dissimilarity to an Italian study which showed metformin to exist more effective. However, CC is typically considered the first-line medication in the United States. The nigh common side effects are gastrointestinal, and include nausea, airsickness, and diarrhea. Metformin therapy is uncommonly associated with liver dysfunction in infertile women, and, in very rare cases, a severe condition chosen lactic acidosis. Claret tests to cheque liver and kidney part should exist done periodically. Other drugs used for diabetics that ameliorate insulin sensitivity, such equally rosiglitazone and pioglitazone, also have been used for this purpose. For more information, please encounter the ASRM Fact Sheet titled Insulin Sensitizing Agents and PCOS.

Gonadotropins

Gonadotropins are fertility medications that contain FSH or LH lone or together. Unlike CC, aromatase inhibitors, and insulin-sensitizing agents that are taken past mouth, gonadotropins are delivered by injection. In that location are a variety of gonadotropin preparations, and others are in various stages of research and development. Because of rapid changes in the international marketplace, the medicines named in the sections below may non include all those bachelor in the United states of america and worldwide.

Gonadotropins might be prescribed for anovulatory women who have tried CC without conceiving. They also are used to help women whose pituitary gland does not produce enough FSH and LH. Gonadotropins are used to cause multiple follicles to develop simultaneously for fertility treatments with superovulation-IUI and IVF. Information technology is important to note that using gonadotropins does not "use up" more than eggs than a nonmedicated menstrual cycle. Gonadotropin therapy tin can rescue the eggs that would normally dice off allowing those eggs to likewise mature and be available for retrieval or conception.

For non-IVF superovulation cycles, the gonadotropin treatment usually begins on twenty-four hours two or three of the menstrual cycle and the usual starting dose is 75 to 150 IU injected daily. Typically, seven to 12 days of stimulation is enough merely this may be extended if the ovaries are slow to respond. The size of the follicles is monitored with ultrasound, and the blood estradiol level also may exist measured frequently, both during the stimulation stage of handling. If blood estradiol levels practice not ascension and ultrasound shows that the ovaries are not responding to gonadotropins, the dose may be increased, or, less ordinarily, the bike may be cancelled. The goal is to accomplish one or more mature follicles 12

and an advisable estradiol level so that ovulation tin be triggered by hCG to mimic the natural LH surge. If also many follicles develop, or if the estradiol level is too high, the doctor may decide to withhold the hCG injection rather than risk the development of ovarian hyperstimulation syndrome (OHSS) or a high-order (more than than twins) multiple pregnancy.

Human Chorionic Gonadotropin (hCG)

hCG is similar in chemical structure and part to LH. An injection of hCG mimics the natural LH surge and causes the dominant follicle to release its egg and ovulate. The doctor may apply ultrasound and blood estradiol levels to determine when to requite hCG. Ovulation will usually occur near 36 hours after hCG is administered. hCG is typically used to trigger ovulation with gonadotropins, and may be used when CC or aromatase inhibitors are used to induce ovulation. It is important to retrieve that a pregnancy test works by detecting hCG; in a pregnant woman, hCG is produced by the implanting embryo and developing placenta. Pregnancy tests (either blood or urine) may be falsely positive if done less than 10 days afterwards an hCG is given to trigger ovulation since the balance hCG is nevertheless present.

Side furnishings of gonadotropins

As with all medicines, at that place are potential risks and complications associated with the utilize of gonadotropins. Side effects should exist discussed before taking these (and whatsoever other) drugs. One of the most common risks is becoming pregnant with more than one fetus (multiple pregnancy). Upwards to thirty% of gonadotropin-stimulated pregnancies are multiple. Of these multiple pregnancies, about 2-thirds are twins and one-3rd are triplets or more. Multiple pregnancy holds health concerns for the mother and babies. Preterm delivery is more common in multiple pregnancies; the greater the number of fetuses in the uterus, the greater the risk. Preterm delivery can be associated with serious health consequences for the newborn such as astringent breathing problems, bleeding within the brain, cognitive palsy, infections, and fifty-fifty death. For women who are meaning with more than twins (such as triplets, quadruplets or a higher number of fetuses), a procedure known every bit multifetal pregnancy reduction is an pick that can help reduce the run a risk of bug resulting from a high-guild multiple pregnancy.

In improver to issues associated with high-society multiple pregnancy, another serious possible side effect of gonadotropin therapy is ovarian hyperstimulation syndrome (OHSS). In OHSS, ovaries become bloated and painful. In severe cases, excessive fluid collects in the abdominal cavity (ascites) and occasionally in the breast. In up to 2% of gonadotropin cycles,

hyperstimulation may exist severe enough to require hospitalization. Conscientious monitoring with ultrasound, measurement of serum estradiol levels, and adjustment of gonadotropin dosage will aid the md to identify risk factors and subtract the hazard of severe OHSS. When serum estradiol levels are ascension quickly, are too high, or an excessive number of ovarian follicles develop, 1 of several strategies can exist used to decrease the chance or severity of OHSS. Gonadotropin stimulation can exist stopped and hCG administration delayed until estradiol levels plateau or decline ("coasting"). Alternately, hCG can be completely withheld so that ovulation fails to occur. Another strategy in women not on leuprolide acetateis to substitute a GnRH agonist for hCG to trigger ovulation, thereby dramatically decreasing hyperstimulation risks.

Other potential side effects of gonadotropin handling include breast tenderness, swelling or rash at the injection site, abdominal bloating, mood swings, and mild abdominal hurting. Some women feel mood swings during gonadotropin therapy, although usually less astringent than those that occur with CC. Information technology is difficult to split the emotional changes due to the hormone levels seen during gonadotropin therapy from the stress associated with fertility treatment. Regardless of the cause, a modify in mood is not uncommon during gonadotropin therapy.

Bromocriptine and Cabergoline

Some women ovulate irregularly or not at all because their pituitary gland secretes too much prolactin. Higher-than-normal blood levels of prolactin (hyperprolactinemia) inhibit the release of FSH and LH, leading to disruption of development of a dominant follicle and ovulation. In some women, loftier prolactin levels tin result from a benign tumor that is composed of prolactin secreting cells, called an adenoma. High prolactin levels besides can issue from the use of certain drugs such as tranquilizers, hallucinogens, painkillers, alcohol, and, in rare cases, oral contraceptives. Diseases of the kidney or thyroid may also raise prolactin levels.

Hyperprolactinemia ofttimes is treated with bromocriptine or cabergoline which act by reducing the amount of prolactin released by the pituitary gland. Blood prolactin levels render to normal in 90% of patients who have these medications. Bromocriptine is typically taken daily. Cabergoline is taken twice weekly. Of the women treated, approximately 85% volition ovulate and can become significant if no other causes of infertility are present. Treatment is unremarkably discontinued one time pregnancy is achieved. Women who do not ovulate later on their prolactin levels are normal may also exist started on CC or gonadotropins.

Possible side furnishings of bromocriptine and cabergoline include nasal congestion, fatigue, drowsiness, headaches, nausea, and vomiting, fainting, dizziness and decreased blood pressure. For well-nigh patients, adjusting the dosage can minimize or eliminate these side effects. Some doctors start their patients on a very depression dose and increment it gradually in an effort to preclude side effects. The risk of multiple pregnancies is non increased every bit a result of bromocriptine or cabergoline therapy when taken without other fertility medications.

Gonadotropin-releasing Hormone (GnRH)

GnRH is released from the hypothalamus in small amounts about once every 90 minutes. This pulsatile (rhythmic) release of GnRH from the hypothalamus into the blood stream stimulates the pituitary gland to secrete FSH and LH. If GnRH is not beingness released properly, it tin exist given every bit a series past a special drug-commitment organization that includes a chugalug property a lightweight pump. The pump delivers a small amount of GnRH every 60 to 90 minutes through a needle placed beneath the peel (usually in the belly) or into a claret vessel. The risk of multiple births and OHSS, are quite small-scale. Now, GnRH is non bachelor for this apply in the United States.

GnRH Analogs (Agonists and Antagonists)

GnRH analogs are constructed hormones like to natural GnRH, but are chemically modified to change their function (typically making them concluding longer). Leuprolide acetate, nafarelin acetate, and goserelin acetate are GnRH agonists. The normal pulsatile rhythmic release of GnRH from the hypothalamus stimulates the pituitary gland to secrete FSH and LH. Withal, when a woman takes a GnRH agonist, her pituitary gland is exposed to a constant, rather than a pulsatile, blueprint of synthetic GnRH. This steady exposure causes an initial rise in FSH and LH production followed by a decline in further release and thereby prevents spontaneous ovulation.

Ganirelix and cetrorelix acetate are GnRH antagonists, which immediately suppress the production of FSH and LH without the initial rise in production that is seen with agonists.

Both agonists and antagonists are ineffective when taken orally. Both GnRH agonists and antagonists can prevent ovulation from occurring spontaneously which allows eggs to be retrieved from developing follicles and used with most all IVF cycles.

The woman taking a GnRH antagonist or agonist long-term may have temporary side furnishings of menopause, including hot flashes, mood swings, and 15

vaginal dryness. In improver, headaches, indisposition, decreased breast size, pain during intercourse, and os loss may occur with long-term use. These side effects are temporary as the effects on the pituitary are reversed after GnRH analogs are discontinued.

LONG-TERM RISKS OF OVULATION DRUGS

After years of clinical employ, doctors can advise patients confidently that CC and gonadotropins are not associated with an increased risk of birth defects. It is also clear, after years of report, that women taking ovulation-inducing drugs such every bit CC and gonadotropin may not be at increased risk for ovarian cancer. Long-term data about the use of aromatase inhibitors is growing and, is besides reassuring.

CONCLUSION

Infertility due to disorders with ovulation tin oft be corrected with various medications and treatments that atomic number 82 to the growth and development of a mature egg that will ovulate.

Many of the medications used to induce ovulation can likewise be used to grow multiple eggs at once (superovulation) in conjunction with additional treatments, such as IUI and IVF to treat other types of infertility.

GLOSSARY

Amenorrhea. Absence of menstrual periods.

Anovulation. A state of failure to ovulate; this tin can be transient or chronic.

Biopsy. A tissue sample taken for microscopic test.

Controlled ovarian stimulation (COS). Administration of fertility medications in order to achieve the development of 2 or more mature follicles. Also chosen superovulation

Corpus luteum. A mature follicle that has complanate subsequently releasing its egg at ovulation. The corpus luteum secretes progesterone and estrogen during the 2nd half of a normal menstrual cycle. The secreted progesterone prepares the lining of the uterus (endometrium) to support a pregnancy.

Embryo. The earliest stage of man development after a sperm fertilizes an egg.

Endometrium. Uterine lining that sheds monthly to produce a menstrual menses.

Estradiol. The main type of three types of estrogen that is produced past the ovaries.

Estrogen. The female sex activity hormone produced by the ovaries that is responsible for the development of female person sex characteristics. Estrogen is largely responsible for stimulating the uterine lining to thicken during the showtime half of the menstrual bike in training for ovulation and possible pregnancy. It too is important for healthy bones and overall health. A small amount of this hormone also is fabricated in the male testes.

Fallopian tubes . A pair of hollow tubes attached one on each side of the uterus. The egg travels from the ovary to the uterus through narrow passageways within these tubes.

Fimbriae. The finger-like projections of the fallopian tubes that sweep over the ovary and move the egg into the tube.

Follicle. A fluid-filled cyst located but beneath the surface of the ovary, containing an egg (oocyte) that is surrounded by hormone producing cells (granulosa cells). The sac increases in size and book during the first half of the menstrual cycle, and at ovulation, the follicle matures and ruptures, releasing the egg. Every bit the follicle matures, it tin can exist visualized by ultrasound.

Follicle Stimulating Hormone (FSH). Produced by the pituitary gland, FSH is the hormone responsible in women for stimulating ovarian follicles to abound, stimulating egg development and the production of estrogen. In men, FSH travels through the bloodstream to the testes and helps stimulate them to produce sperm. FSH tin can also be given every bit a medication.

Follicular phase. The get-go half of the menstrual bicycle (first on twenty-four hours ane of bleeding) during which the ascendant follicle secretes increasing amounts of estrogen.

Gonadotropin-releasing Hormone (GnRH). The natural hormone secreted past the hypothalamus that prompts the pituitary gland to release FSH and LH into the bloodstream, which in turn stimulate the ovaries to produce estrogen and progesterone (FSH), and to ovulate (LH).

Human chorionic gonadotropin (hCG). A hormone produced by the placenta during pregnancy that mimics the LH surge. It is often used with clomiphene or hMG to cause ovulation.

Hyperprolactinemia. High levels of prolactin in the bloodstream.

Hypothalamus. A thumb-sized expanse in the encephalon that controls many functions of the body, regulates the pituitary gland, and releases GnRH.

Hysterosalpingogram. An X-ray performed after dye is injected into the uterus and fallopian tubes to determine if both fallopian tubes are open and if the shape of the uterine cavity is normal.

In vitro fertilization (IVF). A method of assisted reproduction that involves surgically removing an egg from the woman's ovary and combining information technology with sperm in a laboratory dish. If the egg is fertilized, resulting in an embryo, the embryo is transferred to the adult female's uterus.

Insemination. The deposit of semen through a syringe inside the uterine cavity or cervix to facilitate fertilization of the egg.

Laparoscopy. A surgery performed in which a thin camera is inserted into the abdomen through a small incision to inspect the condition of the pelvic organs.

LH surge. The secretion, or surge, of large amounts of luteinizing hormone (LH) by the pituitary gland. This surge is the stimulus for ovulation to occur.

Luteal phase. The second half of the menstrual cycle afterward ovulation when the corpus luteum secretes big amounts of progesterone as well as estrogen.

Luteal phase defect. A shorter than normal luteal phase or one with bottom progesterone secretion despite a normal duration.

Luteinizing hormone (LH). The hormone that triggers ovulation and stimulates the corpus luteum to secrete progesterone.

Multifetal pregnancy reduction. Likewise known equally selective reduction. A procedure to reduce the number of fetuses in the uterus. This process may be considered for women who are pregnant with multiple (more than two) fetuses. As the gamble of extreme premature delivery, miscarriage (spontaneous ballgame), and other problems increases with the number of fetuses present, this process may be performed in an endeavour to prevent the entire pregnancy from miscarrying (aborting).

Ovarian hyperstimulation syndrome (OHSS). A possible side-outcome of controlled ovarian stimulation treatment with fertility medications, particularly injectable hormones, in which the ovaries go enlarged due to development of many follicles, are painful and swollen, and fluid may accumulate in the abdomen and breast.

Ovarian reserve. Quantity of eggs available at whatever age and reflects a woman's fertility potential. Diminished ovarian reserve is associated with depletion in the number of eggs and also may be associated with worsening of egg quality.

Ovulation. The expulsion of a mature egg from its follicle in the outer layer of the ovary. It usually occurs on approximately day 14 of a 28-day cycle.

Pituitary gland. A minor gland just below the hypothalamus that secretes follicle stimulating hormone and luteinizing hormone, which stimulate egg maturation and hormone production past the ovary.

Polycystic ovary syndrome (PCOS). A condition characterized by chronic anovulation, excessive ovarian production of testosterone and/or ovaries with many pocket-size cystic follicles. Symptoms may include irregular or absent menstrual periods, obesity, infertility, excessive hair growth, and/or acne.

Progesterone. A female person hormone secreted by the corpus luteum after ovulation during the 2nd half of the menstrual bicycle (luteal stage). Information technology prepares the lining of the uterus (endometrium) for implantation of a fertilized egg and allows for complete shedding of the endometrium at the time of catamenia. In the event of pregnancy, the progesterone level remains stable beginning a week or so afterwards conception.

Progestin. A synthetic hormone that acts similar to progesterone.

Prolactin. A pituitary hormone that stimulates milk production and interferes with ovulation by inhibiting FSH and LH release.

Superovulation. Administration of fertility medications in lodge to achieve the development of two or more mature follicles. Likewise called controlled ovarian stimulation.

Ultrasound. High frequency sound waves that produce an paradigm of internal organs on a monitor screen.

Uterus (womb). The muscular organ in the pelvis in which an embryo implants and grows during pregnancy. The lining of the uterus, called the endometrium, produces the monthly menstrual blood period when there is no pregnancy.

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Source: https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/medications-for-inducing-ovulation-booklet/

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