General Fertility Treatments

• development and release of the egg 
• likelihood of fertilisation by the sperm to develop an embryo
• transport of the developing embryo through the fallopian tubes
• implantation of the embryo in the endometrial cavity
• maintenance of implantation and growth of embryo/pregnancy

Hormonal therapy is used to encourage the development and release of an egg by the follicle, when is not occurring naturally.

Medications to do this include:

• clomiphene
• tamoxifen
• letrozole 

These medications are taken in the early stages of the follicle development (day 2 to 6 of the cycle) and follicle tracking scans are used to assess the progress of this developing follicle.

Once the follicle has achieved a good size of around 16 to 18mm (usually at day 14) a pregnancy can be attempted. All other parameters will have been checked prior to this. (fallopian tubes, uterus, semen analysis)

In some cases, if ovulation does not occur an HCG injection will be given when the dominant follicle is of a good size to encourage ovulation.

If ovulation does not occur with clomiphene, tamoxifen or letrozole, the follicle may respond to direct stimulation by FSH injections such as:

• Gonal F
• Menopur

These are given daily from the beginning of the cycle and, once again, the development of the follicle is tracked with an ultrasound.

With all types of ovulation induction, ultrasound is important to ensure that no more than one, or maximum two, dominant follicles are present to avoid multiple pregnancy.