Ovulation is one of the key factors for a successful pregnancy. If the egg does not mature and release naturally, this process can be supported with medical treatment. This is called ovulation induction or follicle stimulation therapy. In ovulation induction, the goal is to help the egg mature and ovulate so that fertilization can occur naturally, either through intercourse or insemination. Ovulation induction is recommended if the woman’s menstrual cycle is irregular or absent. Even with a normal cycle, hormonal support may be used to promote follicle development and egg release.
Before starting treatment, it’s important to understand the cause of the ovulation disorder and whether the situation can be improved with other measures. A common cause of ovulation disorders is polycystic ovary syndrome (PCOS). Other medical conditions, such as thyroid disorders (hypothyroidism or hyperthyroidism) or rare pituitary gland disorders, should also be identified and treated. Difficult weight issues (underweight and overweight) or excessive exercise can disrupt ovulation. As women age, particularly after the age of 35, both the number and quality of eggs tend to decline, making conception more difficult.If the ovulation disorder is caused by ovarian insufficiency, medication may unfortunately not be effective.
The aim of ovulation induction is to stimulate the ovaries with hormonal medication to produce and release one or two mature eggs per menstrual cycle. Depending on each patient’s situation, treatment can be combined with timed intercourse or insemination.
Ovulation induction medication can be taken as tablets or as injections under the skin. Most commonly, tablet-based treatment is used first.
Tablet treatment is typically relatively simple. In Estonia, the most commonly used medication contains letrozole, an aromatase inhibitor. It temporarily lowers estrogen levels, prompting the body to compensate by increasing estrogen production, stimulating follicle growth and egg maturation for ovulation. Tablets are taken for five days at the beginning of the cycle. Side effects are rare and usually mild.
The progress of treatment (number and size of follicles and thickness of the uterine lining) is monitored with ultrasound, typically requiring only one visit per cycle. If necessary, injectable gonadotropins can be added. Once it’s confirmed that the medication is working effectively (one ovulating follicle and sufficient lining), letrozole treatment may be continued in future cycles without ultrasound checks, following the doctor’s instructions. It is crucial to evaluate the treatment’s effect during the first cycle; otherwise, continued use would be unnecessary.
If tablet treatment alone is not sufficient, ovulation can be stimulated using injectable medication. Treatment usually begins on days 2–5 of the cycle, with small daily injections of gonadotropin hormones. Response is monitored with ultrasound scans every few days to track follicle growth and uterine lining thickness. If needed, blood tests can be used to measure hormone levels, though ultrasounds are often sufficient. The injections are easy to use and come with very thin needles. Our nurses at Ovumia will carefully guide you through the process at the clinic.
Careful monitoring during ovulation induction increases the chances of pregnancy and reduces the risk of complications (multiple pregnancies). For best results, intercourse or insemination should be timed around ovulation. Ovulation can be detected with an at-home urine ovulation test (LH test).
If ovulation is the only factor affecting fertility, the chances of success are very high.
If ovulation cannot be achieved or pregnancy has not occurred after 4–6 cycles, other fertility treatments may be considered.
