If a woman is not ovulating by herself then ovulation induction may be required. The most common causes of failure to ovulate are stress, weight fluctuations and Polycystic Ovarian Syndrome (PCOS). Other causes may include disorders of the pituitary gland, thyroid gland and raised prolactin levels. In some cases failure of ovulation is due to the ovarian failure. This may occur following treatment for cancer or may be the start of the menopause - premature ovarian failure.
If a woman has an irregular menstrual cycle, monitoring with ultrasound scans (follicle tracking) and hormone assessments may help to identify the fertile time of the month and so improve the chances of natural conception.
Before ovulation problems can be treated it is important to undertake certain tests to establish the cause. These tests include an ultrasound scan of the ovaries and womb and blood tests to measure a range of hormones including thyroid, prolactin, FSH, LH, Testosterone and other androgens (male hormones). It is also important to ensure that the ovary is capable of responding to the drug treatment. One possible cause of failed ovulation is ovarian failure more commonly known as the menopause. If the FSH (> 10) concentration level is high and the AMH concentration is low when measured at the start of a period, ovarian failure is likely. In such cases fertility treatment is less successful.
If ovulation does not occur, then medications may be administered with the onset of menstruation to stimulate egg production. If tablets are not effective then more powerful fertility injections may be necessary to stimulate egg production in the ovaries.
Ovulation is induced using one of two main drug regimens:
The response to any drugs given is monitored by ultrasound scans. When follicles have reached an appropriate size intercourse is advised, or an injection of HCG is given to facilitate the timing of intercourse or IUI. Individual responses to treatment can be unpredictable and if, during the monitoring, the response is insufficient or too strong, the cycle may have to be cancelled and restarted as appropriate. If the response to the drugs is satisfactory, treatment usually continues for 6 cycles; treatment cycles can be carried out consecutively without a break. Potential side effects are mainly related to the drugs. Multiple pregnancies are a risk of ovulation induction treatments. Twins can result in up to 10% of cases with Clomiphene treatment, and 20% with gonadotrophins. Triplets may also occur in around 1% of cases. With careful monitoring the risk of multiple pregnancies is reduced but not eliminated.
Women with PCOS who are not ovulating are normally given Clomid as first line treatment and usually respond very well to this. Two other treatment options may be used:
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IMPORTANT INFORMATION ON BLOOD TESTING DUE TO COVID-19
If you are experiencing symptoms associated with COVID-19, e.g. fever, loss of taste or continuous new cough, please DO NOT attend for a blood test.
Earlier this year, the Government revised the guidance on Shielding for CEV patients. All those who have been identified as CEV have been advised to follow the same guidance as everyone else, whilst potentially thinking about extra precautions you could take to reduce your chance of catching COVID-19.
Taking into account this guidance, and the evidence that most patients have now resumed having their blood tests at their usual preferred location, UHCW will no longer be providing the Shielding phlebotomy service from Monday 13 December 2021. You will need to make arrangements to get your blood tests done, as you did prior to the pandemic at locations across Coventry and Warwickshire at www.uhcw.nhs.uk/bloodtests If your specialist has requested a blood test which is due to be taken prior to Monday 13th December, you can expect it to take place at a ‘Pop-up’ clinic, as before. Any blood tests required after this date will need to be a booked appointment.
You can keep up to date with the latest advice from the Government and from UHCW on the following website: www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
Click on the map for information about phlebotomy clinics in Coventry. You can book an appointment online at the locations in red.
Please book an appointment before attending for a blood test. Click on the ‘Book Online’ button above. Booking an appointment helps patients, their carers and family members to plan their hospital visit better, helping to reduce clinic waiting times and enabling patients to be seen much more quickly.
Location: Outpatients Department, on the ground floor. Opening hours: 8am-4.45pm, Monday to Friday (excluding bank holidays).
Children under 16 years old will need to book online here.
Please book an appointment before attending for a blood test, click on the ‘Book Online’ button above. Patients from Rugby and the surrounding areas are able to access the Friends Blood Taking Unit at the Hospital of St Cross.
Referrals for blood tests can be from GP's, practice nurses or from hospital consultants. Patients are also able to leave other samples, such as urine, which have been collected at home, at the hospital's Pathology Reception.
Location: Near Brookfield House, just off North Road - map here. Opening hours: The blood taking clinic sessions for adults and children are listed below:
Monday -Friday 7am-4:45pm Appointment only
Wednesday Evening 5pm-7pm Suspended due to COVID
Saturday Morning 7am-10pm Suspended due to COVID
April 2020 NEW - This Clinic is now by appointment. Please book an appointment before attending for a blood test. Click on the ‘Book Online’ button above.
Address: Stoney Stanton Road, Coventry CV1 4FS Location: Access is via the main doors, the Phlebotomy team are in Area A. Opening hours: Monday to Friday (excluding bank holidays). 8am–4.45pm
Glucose Tolerance Test (GTT)
Specialist Tests - There are a small number of specialist tests where blood needs to be taken on a hospital site as the sample must be transferred to the laboratory rapidly for the test to be undertaken. Click here for a list of these specialist tests and to find out more.