Before pregnancy can occur, the egg cell must mature and be released from the ovary to the fallopian tube. This moment is called ovulation. Ovulation usually happens in the middle of the menstrual cycle. If the cycle is 28 days long, ovulation occurs on the 14th day.
The menstrual cycle is a susceptible system. It is regulated by the hypothalamus( CNS) and pituitary gland. It can be disturbed easily and end up in anovulation,
For example, stress, changes in body weight, and too short a night’s sleep can cause anovulation. Women with Polycystic Ovarian Syndrome (PCOS) often suffer from infertility due to irregular ovulation.
It might also be that a woman has regular periods; everything seems normal, but pregnancy has not started after trying for some time. When the cause of infertility is unknown, ovulation induction is often used as the first treatment option since it can help develop follicles and ovulation.
The principle of ovulation induction is to enhance ovulation by stimulating the ovaries with medication to produce one follicle and one mature egg per cycle. Medication can be administered as tablets or injections under the skin.
Currently, letrozole is the primary oral medication used for inducing ovulation. Tablets are taken once a day for five days, shortly after a menstrual cycle begins. Letrozole is an aromatase inhibitor. It is also used to treat certain types of breast cancer in women after menopause. When Letrozole blocks the activity of aromatase, it causes a decrease in estradiol levels. This leads to the release of the hypothalamic/pituitary axis from estrogenic negative feedback, which increases FSH secretion and stimulates ovarian follicle growth. Gonadotropin injections are necessary if tablet treatments do not work or if pituitary hormones are secreted too little.
The progress of the ovulation induction is monitored with ultrasound examinations(the number and size of the follicles and the thickness of the endometrium) and measuring the progesterone level a week after assumed ovulation. Follow-up improves the chance of getting pregnant and reduces possible risk factors (multiple pregnancy). For the treatment to be successful, intercourse must be timed near the time of ovulation. A urine ovulation test (LH test) sold at a pharmacy can be used to help with timing.
The chance of pregnancy with ovulation induction is around 10-15% per cycle. By using the medication for several cycles, the probability of pregnancy increases.
Other therapies should be considered if pregnancy is not achieved within 4–6 cycles.
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