Timed Sexual Intercourse

Ovulation induction and timed sexual intercourse

Ovulation is a part of menstrual cycle. It occurs when an egg is released from the ovary. It typically happens around day 14 of a 28 day menstrual cycle. However, not every woman has 28 days cycle, so the time of ovulation can vary depending upon the length of cycle.

The process of ovulation begins with the release of follicle stimulating hormone (FSH) from your pituitary gland (brain). This hormone is responsible for growth of a single follicle inside the ovary. Once the follicle achieves the optimal size (17-24 mm) under the influence of FSH, your brain releases another hormone which is called luteinizing hormone (midcycle LH surge) which causes ovulation. It usually happens 28-36hrs after LH surge. This is the hormone that is detected in the commercial ovulation kits. This cyclic behavior of the hormones and ovulation is what gives ovulating women regular menses (defined as a variation of not more than 8 days between cycles).

When this ovulation process fails, patients present with irregular menses. In a study concluded in 2003, only 3% of women that had regular menses were not ovulating. This study concluded that in general terms, women with regular menses are ovulating.

In about 25% of couples with infertility, ovulatory dysfunction can be the cause. The one most common cause is polycystic ovarian syndrome.  It usually presents with women with very irregular cycles. When a couple is trying to conceive and ovulation is not happening, then fertilization and pregnancy become very difficult.

The only solution in these couples is to make the female ovulate. This is the main indication for ovulation induction treatments with timed sexual intercourse (TSI).

Pre-requisite of Ovulation induction with TSI

  • Normal semen analysis
  • Healthy and patent fallopian tubes

Agents used for ovulation induction

  • Clomiphene citrate (Clomid)
  • Letrozole ( Femara)
  • Follicle stimulating hormone injection

Steps in typical ovulation induction/TSI cycle

  • You start your prescribed treatment (tablet or injection) from cycle day 2-3
  • You attend for follicular tracking scan between cycle day 10-12. It is best care practice to attend for this follicular tracking scan in every cycle of TSI because there can be more than 1 follicle growing and the risk of multiple pregnancies can be considerable.
  • Once your follicle achieve the optimum size of > 18mm, you receive a trigger injection (a hormone that works just like that LH surge) to promote the release of egg from the follicle.
  • You are advised to perform sexual intercourse the same evening and next day
  • We advise you to take progesterone support in the form of vaginal gel, suppositories or injections.
  • Pregnancy test is performed two weeks later