The meaning of this term is to induce unifollicular or multifollicular ovulation in a single menstrual cycle with the help of medications which can either be administered orally or via injections, subcutaneously or intramuscularly
- Anovulatory cycle ( like PCOS)
- Unexplained infertility
- In accompaniment with timed intercourse cycles, intra uterine insemination cycles or for IVF-ICSI cycles.
Superovulation – this term is basically used in IUI or timed intercourse cycle, in which it is aimed to have 2-3 eggs in a single menstrual cycle.
Rationale – Usually a woman ovulates a single egg in one menstrual cycle. However having 2-3 egg released in a single cycle could improve the probability of pregnancy with a slightly increased risk of twin or triplet pregnancy.
Controlled ovarian hyperstimulation – this term is used in IVF – ICSI cycles, in which it is aimed to have 10-15 mature eggs from a single menstrual cycle.
Rationale – having more egg for IVF-ICSI cycles allows formation of more embryos and hence quality selection of best grade embryos can be done for embryo transfer / embryo freezing.
This pyramid shows how a number of eggs is lost at each stage of the IVF-ICSI process and hence COH becomes an inseperable part of a conventional stimulation cycle.
Ovulation induction is done with the help of following agents:
- Oral medications
- GnRH agonist and antagonists
- Monitoring is done with the help of trans vaginal sonography to monitor the follicular (fluid filled sacs which contain eggs) number and size and serum estradiol level in certain cases when deemed necessary.
- Trigger injection is administered once follicles mature sized about 18 – 20 mm with good vascularity.