Ovulation induction simple

 PRACTICAL TIPS FOR INFERTILITY MANAGEMENT

Letrozole / Clomiphene should be given maximum for 3 months with USG monitoring.

Dose of Letrozole 2.5 mg , and in next cycle 5 mg , If anovulatory may be extended for 10 days . Sometimes CC is supplemented with letrozole in same cycle while cc acting centrally at hypothalamic levels and Aromatase inhibitors decreases ovarian biosynthesis of androgens  making Follicular fluid congenial for having optimum nutrition to growing oocyte and normal paracrine functions. This will prevent abortion which is so common in anovulatory PCO women due to incompetency of fertilized ova to grow properly, CC should be up to 100 mg for 5 days. Extended regimes are not useful in clinical practice.

hCG should be combined with CC only when IUI is to be done or delayed LH surge is suspected.

CC + Oestrogen have no role.

CC + bromocryptin for spikers and galactorrhea. Empirical use of bromocryptin has no role.

CC + Dexamethasone in CC resistant chronic anovulatory obese PCOS or with proven DHEASO4 > 200 mcg /ml