Ovulation induction and IVF for infertility

Question 1

Explain ovulation induction using letrozole to a patient

Answer 1

• Letrozole is a tablet medication. It is an aromatase inhibitor. How it works is it reduces the conversion of androgens into oestrogens by an enzyme called aromatase. The lower level of oestrogens reduces the negative feedback on the pituitary leading to increased production of FSH therefore encourages the development of ovarian follicles.
• Risks: rarely multiple pregnancy, OHSS and borderline ovarian tumour
• Side-effects: menopausal sx (hot flushes, fatigue, dizziness)

Procedure:

• Begin after spontaneous or withdrawal bleed.
• Start letrozole 2.5 mg daily day 3-7.
• Commence having sex every other day after letrozole stopped.
• You may have an ultrasound around day 10 to check a follicle is developing.
• You may be asked to have a blood test to confirm you have ovulated (day 21 progesterone level).
• If you do not ovulate this cycle, we increase the dose of letrozole next cycle by 2.5mg up to a maximum of 7.5mg daily.
• Maximum number of recommended cycles is 12.

Question 2

Explain IVF process to a patient

Answer 2

• In-vitro fertilisation is where an egg is removed from a woman’s ovaries and mixed with sperm in a lab in order to fertilise the egg. The fertilised egg or embryo is then returned to the woman’s uterus to grow.
• Risks:

Process:

• We give you the COCP to suppress your natural menstrual cycle prior to beginning IVF.
• 1 week later you will start giving yourself injections of leuprolide acetate (GnRH agonist) to prevent the body from releasing hormones that could stimulate ovulation.
• Around day 3-5 you will start giving yourself FSH injections (gonadotrophin) to stimulate the growth of egg follicles.
• Regular blood tests for hormone levels and pelvic ultrasounds are needed to monitor development of follicles. When follicles are around 14mm a GnRH antagonist (cetrorelix or ganirelex) to prevent premature ovulation.
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