The first step toward artificial insemination is undergoing controlled ovarian hyperstimulation, while monitoring the whole process in order to ensure that everything is going well.
Ovulation induction is performed by prescribing medicines which contain clomifene (INN), a.k.a. clomiphene (USAN), or gonadotropins (FSH and LH) taken in low doses from day 2 or 3 of the cycle (it is considered as day 1 the first day of menstruation). They may be sold under different trade names.
This process takes usually between 8 and 14 days.
The hormones may be injected either subcutaneously or intramuscularly, depending on the medical guidelines. These guidelines are established according to several factors such as the patient’s age, the morphology of the ovaries, the body mass, the hormone analysis, and the response to induction in previous cycles.
Specialists usually adapt the medication and the most adequate doses to each women rather than standardising the treatment.
The monitoring process is performed by means of periodic transvaginal ultrasounds. Its purpose is to control the number of follicles within each ovary, to schedule the exact insemination date, and to measure the endometrial thickness.
The gynaecologist checks the progress of follicular ripening until the follicles are approximately 18 millimetres in diameter. In this moment, they are considered to be mature enough and that is when the hCG hormone is administered to trigger ovulation.
This allows the exact insemination date to be calculated.