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Sunday, 23 March 2014

Ovulation Induction in PCOD

Women with PCOD are a diverse group and therefore the management has to be done by a fertility specialist.  In case you do not have regular periods, the doctor will need to give you medications to bring on a period. In women with PCOD, there are many antral follicles in the ovaries that are in a suspended state and these can respond to hormones. The biggest challenge therefore is that any hormonal treatment intended to cause ovulation causes many or all of these to start growing leading to multiple ovulations and multiple pregnancy. A complication known as ovarian hyperstimulation syndrome (OHSS) can also result.

The process of ovulation induction is most often done with the help of tablets called Clomiphene citrate. These are typically taken in the dose of either 50mg or 100mg (occasionally higher) for five days from the second or third day of a spontaneous or induced period. This is ideally followed by serial ultrasound scans to track the follicle/s that start to grow and eventually ovulate from one or both ovaries. When ovulation is confirmed, the couple are advised to have relations.

Many women with PCOD do not respond to the tablets in which case, they are advised to start daily hormone injections to induce ovulation. The aim is to give the smallest effective dose that would allow ideally a single follicle (but no more than 6 follicles) to grow and release an egg. This is extremely challenging in PCOD and therefore requires a lot of skill and patience. The doctor may have to cancel the treatment and start again at a lower dose of injections in case too many follicles start growing to prevent OHSS and high order multiple pregnancy. It is however not always possible to prevent multiple ovulations as the ovarian response in women with polycystic ovaries can be either too much or too less!

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