Cycle management
Cycle management
Control, prediction of ovulation
Every therapeutic intervention for infertility involves control and prediction of ovulation. This is useful in the natural cycle and in stimulating ovulation with medications. Just before ovulation, the following may be recommended or performed: timed intercourse, insemination, or egg aspiration for IVF. We manage ovulation:
- cervical mucus examination (characterization of the mucus and cervix)
- USF folliculometry (measurement of follicle growth and maturation)
- determination of LH rise (hormone in urine/blood)
- determination of estradiol (follicular hormone).
Often, instead of determining LH, we inject HCG or GnRH agonists, which are triggers of final oocyte maturation and ovulation. Ovulation follows about 36 hours after triggering. Healthy follicles grow ≈1-2 mm per day, and a mature follicle is 18-20 mm in diameter. The estradiol level in each follicle is ≈200 pg/ml.
About 80% of follicles larger than 16 mm carry a mature egg. Subtract 13 days from the average duration of the last six cycles, and ovulation occurs 70% of the time on that day.
