Ovulation is one of the most important factors in achieving a successful pregnancy. If an egg does not mature or is not released naturally, this process can be supported with medication. This is called ovulation induction or follicle stimulation.
The goal of treatment is to promote egg maturation and ovulation so that conception can occur naturally—either through intercourse or insemination. Ovulation induction is primarily recommended for women whose menstrual cycle is irregular or absent. Even with a regular cycle, hormonal treatment can be used to support ovulation, which helps with follicle development and the release of the egg.
Before starting treatment, it is important to determine the cause of the ovulation disorder and assess whether the situation can be improved through other measures.
The most common cause of ovulation disorders is polycystic ovary syndrome (PCOS). In addition, thyroid dysfunction (both underactive and overactive) or rare pituitary disorders may also play a role. Severe underweight, overweight, or excessive physical exertion can also inhibit ovulation.
As women age—especially after age 35—both the number and quality of eggs decline, making it more difficult to conceive.
If the ovulation disorder is caused by ovarian insufficiency, hormonal medications may unfortunately no longer be effective.
The goal of ovulation induction is to stimulate the ovaries with hormonal medications so that one or two eggs mature and are released during the cycle. Depending on the situation, treatment may be combined with timed intercourse or insemination.
Medications may be in the form of tablets or subcutaneous injections. Treatment usually begins with oral medication.
Tablet treatment is usually simple and well-tolerated. In Estonian infertility treatment practice, the most commonly used medication contains letrozole, an aromatase inhibitor. This temporarily lowers estrogen levels, causing the body to stimulate follicle growth and egg maturation. The tablets are usually taken for five days at the beginning of the cycle. Side effects are rare and mostly mild.
The course of treatment is monitored via ultrasound, assessing the number and size of follicles as well as the thickness of the uterine lining—usually one visit during the cycle is sufficient. If necessary, injectable gonadotropins may also be added. If the medication is effective (one mature follicle has developed and the endometrium is suitable), treatment can continue in subsequent cycles according to the fertility doctor’s instructions, even without ultrasound monitoring.
It is important to assess the treatment’s effectiveness during the first cycle to avoid continuing unnecessary treatment.
If oral medication is insufficient, ovulation can be stimulated with hormones administered via injection.Treatment usually begins on days 2–5 of the cycle, and small doses of gonadotropin are administered daily.
The course of treatment is monitored via ultrasound every few days to track follicle development and the thickness of the uterine lining. Blood tests may be performed if necessary, though ultrasound is usually sufficient.
The injections are simple and use a fine needle; our Ovumia nurses carefully instruct and guide the patient throughout the procedure.
Careful monitoring of treatment increases the likelihood of pregnancy and reduces the risk of complications (e.g., multiple pregnancies).
For the best results, intercourse or insemination should be timed to coincide with ovulation. Ovulation can be determined using an at-home LH test.
If ovulation is the only factor affecting conception, treatment outcomes are usually very good. If ovulation cannot be achieved or pregnancy does not occur after 4–6 cycles, the doctor will recommend considering other fertility treatment options (e.g., IVF).
