Superovulation – Process, Risks and Success Rates

Infertility treatments can be really exhausting both emotionally and physically. Before getting into these treatments, we need to be fully aware of the process, risks attached to it and of course the success rates. This post explains in detail all you need to know about superovulation therapy as a part of infertility treatment.

What Is Superovulation?

We all have heard of IVF (in-vitro-fertility) treatment; superovulation is a part of it. Superovulation refers to the artificial drug-induced production of multiple eggs which can then be used in IVF reproduction technology. In the normal course, a woman ovulates one egg per cycle. In superovulation process, with the help of fertility drugs, she will be able to produce more than one egg, which the doctor will retrieve from the ovaries just before ovulation. More eggs will lead to more embryos. This process thus increases the chances of success rate in IVF.

Who Can Opt for Superovulation

Women who are already ovulating but are unable to conceive can opt for superovulation to improve their chances of getting pregnant by releasing more eggs. Women with open fallopian tubes and whose partners have adequate sperm count can also opt for superovulation. Another case is when women are ovulating with the help of oral medication, but are unable to conceive can also go for superovulation.

Superovulation Process

The superovulation process starts with women releasing extra eggs with the help of oral medication like clomiphene. This involves low cost, less risk and can be considered as a mild form of superovulation.

An ultrasound around the time of ovulation will reveal exactly how many follicles are being released. If only one follicle is released, then the dosage of medicines will be changed accordingly in the next cycle.

Many doctors recommend gonadotropin during superovulation. Gonadotropin is a hormonal medicine that can be injected into the body to initiate ovulation. Women under the medication of gonadotropin ought to be carefully monitored to ensure that they do not produce too many eggs.

Women undergoing the superovulation protocol will be asked to take three days of medication and then return to the clinic for an ultrasound and blood tests. Depending on the response of the ovaries the doctor will ask you to come to the clinic during the next one to three days for additional monitoring.

The doctor then injects the human chorionic gonadotropin (hCG) to initiate ovulation, once the desired number of eggs have matured. In case of Intrauterine Insemination (IUI), you will have to come back to the clinic after 36 hours of hCG injection for the insemination process.

Fertility Drugs That Are Used in Superovulation

Superovulation focuses on two processes, inducing the ovaries to mature more eggs and to prevent premature release of those eggs. The doctor needs to be able to retrieve the eggs from the ovaries before ovulation. If ovulation occurs before the retrieval, then the IVF cycle will have to be cancelled. The following first two medicines are used to induce superovulation, and the last two are injected to prevent premature ovulation.

• Gonadotropin
• Gonadotropins
• GnRH agonists
• GnRH antagonists

How Many Eggs Do You Ideally Need?

The ideal number of eggs you need to be matured solely depends upon your diagnosis report and treatment plan. It also depends on the doctor’s professional experience and opinion. An ultrasound report will reveal how many follicles are produced by your ovaries. The problem is that not every follicle will give you desired quality of egg which can mature into an embryo. Hence, a number of eggs are produced to improve the success rate of your pregnancy. Taking into consideration the above factors, the number of eggs varies from 8 to 15. In case of micro-IVF you just need four or five follicles.

Risks Associated With Superovulation

The following risks are associated with superovulation:

1. Multiple pregnancies

Superovulation increases the risk of multiple births. Around 20-30% of successful IVF pregnancies have resulted in twins or triplets. Superovulation has the highest risk of triplets as compared to other treatment options.

2. Ovarian Hyperstimulation Syndrome

OHSS is a condition wherein the ovaries became enlarged and filled with fluid as a result of gonadotropin medications. Mild forms of OHSS are quite common, and the symptoms involve bloating or slight pelvic discomfort; it goes away immediately after the treatment ends. But in rare cases, OHSS is more severe, and women experience difficulty while urinating, rapid weight gain, dehydration, complications in other organs like kidney and liver and are under high risk of developing blood clots. A woman under gonadotropins medication is closely monitored to significantly reduce the chances of OHSS, and if the patient is at high risk of developing OHSS, then the treatment is cancelled immediately.

3. Ovarian torsion

Ovarian torsion also called ovarian twisting happens in extremely rare cases. As the ovaries get enlarged, it twists on itself, restricting the blood flowing into it. This leads to severe abdominal pain, nausea, vomiting and at times fever. Surgery needs to be performed to resolve the twist.

4. Ectopic pregnancy

When a fertilized egg implants itself outside the uterus say in fallopian tubes, ovaries or cervix, then it is termed as ectopic pregnancy. Ectopic pregnancy is quite rare and happens because many women with infertility have tubal dysfunction and fertility medications cause the release of more eggs. This increases the possibility that not all fertilized eggs move through the tubes into the uterus for implantation.

Side Effects of Superovulation

Any treatment carries a certain amount of risk attached to it. The side effects depend upon the medication dosage and how your body reacts to it. Superovulation may cause the following side effects:

• Nausea
• Headaches
• Off-cycle abdominal bleeding
• Bloating
• Mood swings
• Respiratory disorders
• Weight gain
• Stomach upset
• Dryness in the vagina
• Hot flashes
• Anxiety
• Joint pain
• Redness or swelling on the injection site
• Low sex drive
• Acne

Side effects can be lessened by taking the medicines at night or with food. Also, if the treatment is done with lowest effective dose, the side effects can be lessened.

What Is the Success Rate of Superovulation?

The success rate of the treatment depends upon factors like – treatment used IVF, IUI, mini IVF, diagnosis of the patient, and age of the patient.

In the normal course, IVF success rates are higher compared to the superovulation IUI success rates. Superovulation will not be successful in case of women above 40 years of age and women with primary ovarian failure. In such cases, doctors recommend an egg donor, as the IVF success rate with an egg donor is quite good. Ovarian reserve testing is done to predict whether superovulation will work or not.

Superovulation can definitely increase your chances of getting pregnant through IVF or IUI. Have a detailed discussion with your doctor to understand your situation better and to know if superovulation is the correct treatment for you.

Also Read: What is Anovulation?