Follicular monitoring for timed intercourse

Knowing and tracking your ovulation cycle will be the first step to natural conception. Monitoring your ovulation cycle can be used for examination as well as treatment. A transvaginal ultrasound will be performed to evaluate the uterus & ovaries to look for abnormalities to understand the difficulty in getting pregnant.

Knowing the details can make it easier to predict the ovulation timing, and you can schedule intercourse so that it can coincide with the ovulation time. This can be done either during the natural cycle without any medication or during an ovulation induction cycle using fertility drugs. Observing your natural cycle may be the simplest form of assisted conception.

Sequential ultrasound monitoring of ovarian follicles and assessing the uterus’s endometrial thickness is called follicle monitoring. The purpose of this procedure is to obtain important information about the size and number of follicles that support your growing eggs. The mature egg will ovulate and make sure it is achieved safely.

Menstrual cycles(periods) might vary from one month to another, so tracking over 2 or 3 ovulation cycles might require precise evaluation. The process includes a regular transvaginal ultrasound to monitor the ovaries and track how follicles are growing in the ovaries.

During each menstrual cycle, a group of 10 to 15 antral follicles begins to grow. As estrogen accumulates around the egg, these antral follicles look similar to small fluid-filled cysts. Usually, each follicle holds an egg and is enclosed by granulosa cells. The Granulosa cells surrounding the egg produce follicular fluid, estrogen and support egg development. 

They grow at 2 mm per day, and on the fifth or sixth day of the menstrual cycle, most of these antral follicles are affected by Atresia and grow only one. Every day this growing follicle can be observed with the help of transvaginal ultrasound – this is called follicular monitoring or follicle examination.

The follicle study starts from the 8th to the 10th day of the cycle until the follicle ruptures. Usually, the follicles rupture after reaching 20mm size and in women who have regular menstruation, it ruptures 14 days earlier than expected.

Natural follicular monitoring or ovulation cycle tracking:

No medications are used during the natural follicular monitoring to stimulate the ovaries. Only ultrasound is performed to evaluate the growth of follicles and maturation. It is a non-invasive technique to identify the most fertile days of a woman during a menstrual cycle. It helps to determine the optimal time for sexual intercourse during the cycle to conceive naturally. It also determines whether the cycle is normal.  

Further treatment is decided based on your ovulation cycle tracing results. It is one of the safest fertility treatments free of side effects and also affordable. Usually, women under 30 years of age with regular menstrual cycles and unexplained infertility are ideal candidates.

Natural cycle monitoring or follicular tracking or ovulation cycle tracking:

The process:

  • The follicular tracking procedure starts during menstruation. Some routine tests are performed for the presence of abnormalities like cysts, fibroids and others. The baseline scan starts on day 2 of the cycle.
  • In the following meetings, the growth of the Graafian follicle is evaluated along with the assessment tests for the endometrium growth and ovulation occurrence. (Day 6 & Day 9)
  • Ultrasound scans are done before expected ovulation, and we will check for the ruptured follicle in the next visit.
  • Thus, patients might need to visit the clinic 3-4 times during ovulation.

Timed Intercourse

Once the best ovulation time is established by regular ultrasound scans and tracking the follicles’ growth, the couple is advised to have sex daily for about three days at home. Our expert fertility specialists at ZIVA Fertility & Embryology Clinic say that intercourse should happen close to ovulation. 

Ovulation Induction

This is the next step in infertility management. The process of ovulation induction involves giving the patient medication related to hormone stimulation of the ovaries, and at the same time, promotes multiple follicles to mature. Hormonal stimulation helps in the production and release of eggs. Further, the stimulation process increases the chance of embryo implantation into the lining of the uterus.

Ovulation drugs assist women with irregular ovulation and who are unable to produce a single healthy egg. Some women ovulate regularly but may not produce quality eggs or more eggs to achieve pregnancy. Ovulation-inducing agents are taken in different forms, like tablets (clomiphene/letrozole) or injections (gonadotropins).

The woman’s progress is continuously monitored in the ovarian stimulation stage with the help of hormone testing and ultrasound.

In addition, the fertility medication dosage can be modified based on the results of follicular tracking and hormone tests. Sometimes, the response to treatment might be inadequate or more eggs get matured, which increases the risk of ovarian hyperstimulation syndrome.

Ovulation induction process:

Medication: Ovulation is stimulated by inducing medicines

Follicular Tracking: Transvaginal pelvic ultrasound scans are done regularly to evaluate the follicular development and endometrial lining (endometrium) of the uterus.

Egg Release: HCG(Human Chorionic Gonadotropin) injection is given to trigger ovulation, the final maturation & detachment of the egg from the follicle wall.

Timed Intercourse: It is the ideal time advised by the fertility expert for the couple to have sexual intercourse after evaluating ovulation scans.

A maximum of 4- 6 cycles are tried with this procedure, and if there is no positive result (conception/pregnancy), the fertility expert suggests the couple undergo assisted reproductive techniques like IUIIVFICSI as further fertility treatment.

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