Understanding your ovulation cycle and being able to track it meticulously can be the first step towards conceiving naturally. Cycle monitoring can be both an investigation as well as a treatment. A Transvaginal ultrasound will be performed to assess uterus, ovaries and evaluation in detail will be done to note any abnormalities which could help to explain why a woman may be have difficulty conceiving.
Once the details are known, it is easier to predict when ovulation will occur and intercourse can be timed so that it coincides with the time of ovulation. It can be done in a natural cycle without medicines as well as during an ovulation induction cycle with fertility medicines. Natural cycle monitoring can be your first easiest form of assisted conception. Serial ultrasonic monitoring of the ovarian follicles along with assessment of uterine lining thickness, is the process called as follicular studies or follicular monitoring aims to provide crucial information about the size and the number of follicles that support growing eggs, the mature one that will ovulate and to ensure that this is accomplished safely.
Menstrual cycles may vary from month to month, hence it might be required to track ovulation cycle, over 2 or 3 cycles. To do this, a routine transvaginal ultrasound will be conducted to check the ovaries and to track the follicles growing in the ovaries.
At every menstrual cycle a group of antral follicles, 10-15 in number start growing. As estrogen collects around the oocyte the antral follicles look like small fluid filled cysts. Each follicle usually contains one egg surrounded by granulosa cells. Granulosa cells surround the egg, produce the follicular fluid, produce estrogen, and support the egg in its development. They grow at a rate of 2 mm per day, by the 5th or 6th day of menstrual cycle, majority of these antral follicles undergo artesia and only one grows. This growing follicle can be seen by Transvaginal ultrasound daily- This is called follicular study. The study starts around 8th to 10th day of menstrual cycle and continues till the follicle ruptures. It usually ruptures after it achieves 20 mm size. In regularly menstruating women, follicle ruptures 14 days before expected menses.
Natural cycle monitoring or follicular tracking or ovulation cycle tracking:
No medication or drugs are used to stimulate the ovaries. Only ultrasound assessment of the growth and maturation of the growing follicles is done. It is a non-invasive medical investigation that tests and indentifies the days during woman’s menstrual cycle in which she is most fertile, optimal time during the cycle to conceive naturally through sexual intercourse, also determines if a woman’s menstrual cycle is ‘normal’. Future treatment and advice is given based on the results of your ovulation cycle tracking where we gather information about your physiological menstrual cycle, ovulation, luteal phase and hormonal changes. It is safe, free of side effects, very easy, and the most affordable treatment. Usually young women below the age of 30, with regular menstrual cycles cases of unexplained fertility are the suitable candidates.
Stepwise process:
- Usually the first visit of your follicular tracking process begins at menstruation. Routine checks are done for abnormalities, like presence of cysts, fibroids and others. ( Baseline scan Day2 of Cycle)
- In the subsequent meetings Graafian follicle growth is assessed along with tests to assess the growth of the endometrium and occurrence of ovulation. (Day 6 & Day 9)
- Ultrasound scans are used before expected ovulation and in the next visit we check for the anticipated ruptured follicle.
- Thus patient needs to come to the clinic for a maximum of 3-4 visits.
Timed Intercourse :
Once the optimum time of ovulation is established by ultrasound scans tracking the growth of follicles, by the expert fertility specialists at Anmol Fertility & IVF Centre, couple is advised about the planned relations. Intercourse should occur as close as possible to the ovulation. Thus couples may just require minimalistic intervention useful in some cases.
Ovulation Induction:
This is one of the initial steps towards fertility management. In ovulation induction, patients are treated with hormone medications or fertility drugs involving hormonal stimulation of the ovaries & promoting the simultaneous maturation of multiple follicles. Hormone stimulation will assist in the production and release of egg and it will further improve the embryo’s chance of implanting successfully in the lining of the uterus. Ovulation induction medications are used to help women who do not normally ovulate to produce a single, healthy egg, and women who ovulate but where the quality or number of eggs produced may not be sufficient to achieve a successful pregnancy .Ovulation inducing agents are either in pill form (Clomiphene Citrate/ Letrozole) or injectable form (Gonadotropins) (concentrated forms of the natural hormones, which stimulate ovulation in a normal menstrual cycle.
During the ovarian stimulation stage, the woman’s progress is monitored with hormone testing and ultrasound.
Additionally, the dose of the fertility medication can be adjusted during treatment based on follicular tracking and hormonal tests if there is an inadequate response or if too many eggs start to mature with increased risk for developing ovarian hyperstimulation syndrome.
Stepwise process:
- Ovulation induction with medicines
- Follicular Tracking : Transvaginal pelvic ultrasound scans are used to access the follicular development and endometrial lining (lining of the womb) of the uterus.
- Egg Release: HCG injection to induce ovulation, the final maturation of the egg and loosening of the egg from the follicle wall.
- Timed Intercourse: The couple is advised to have intercourse as per the ovulation scan and days suggested by the doctor.
A maximum of 4- 6 cycles can be tried and in case, there is no positive result (conception/pregnancy), the couple may be suggested to go for further assisted reproductive techniques.