Timed Intercourse
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The stimulation course
Timed intercourse is based upon a simple principle. If we know precisely when the ovulation is going to occur, you also know when a couple needs to have intercourse with ejaculation to have a reasonable chance of pregnancy. This method is often chosen as a primary treatment, especially in
unexplained infertility, which means that no particular cause why a couple is unable to conceive, has been identified.
The stimulation course
The stimulation process for timed intercourse is the same as for artificial insemination:
- either anti-oestrogen is administered orally (clomifeen citrate),
- or gonadotrophins are given in injections.
Side effects are few in both cases. The first method can lead to a swollen abdomen, hot flushes and flashing lights before the eyes. The second method may cause some mild abdominal pain.
oral administration of anti-oestrogens
The oral administration of
clomifeen citrate fools the brain into thinking that there are insufficient levels of oestrogen in the system, which stimulates the production of FSH and LH. These in turn lightly stimulate the ovaries.
If clomifeen citrate is given at the start of the menstrual cycle, it will lead to the simultaneous development of several follicles.
Injections of gonadotrophins
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Subcutaneous injection of gonadotrophins |
Another method is the direct injection of sex hormones (gonadotrophins).
Through the injection of hCG, FSH or rec-FSH (see
hormone preparations) the ovaries are also stimulated into producing several follicles at the same time. The dosages have to be precisely determined, because the intention here is not to trigger a 'super ovulation' like in IVF (see
ovulation-induction), but rather a more gentle stimulation.
The injections are given subcutaneously. You will be shown how to do this yourself or your partner will be taught how to give you the injections.
concluding with hcg injection or not?
Because both stimulation methods lead to a natural LH peak and therefore a natural ovulation 36-42 hours later, the LH levels in the blood must be monitored regularly, in order to be able to determine when the ovulation will occur.
If the LH peak does not really happen effectively, or ultrasound examination reveals that only a few follicles are ripe and bigger than 17mm, it will be decided to trigger ovulation by the injection of hCG.
This too is administered subcutaneously. You may inject it yourself at home, but the precise moment when it is to be given will be decided by the DPM.
The treatment in detail
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Click for instructions regarding clomifeen citrate |
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Click for instructions regarding gonadotrophins |
- On day 1 of your cycle (the first day of bleeding) you call the DPM (daily patient monitoring), the team that monitors and follows your treatment and arranges blood tests and ultrasound scans. You make an appointment for an ultrasound on day 12 of your cycle (or day 11 if this falls on a sunday or bank holiday).
- Stimulation using anti-oestrogens:
you take the prescribed dose every day from day 3 up to and including day 7.
- Stimulation using injections of gonadrotophins hCG or rec-FSH:
you follow your doctors' instructions regarding which medicine and on which day to commence the treatment and when to stop.
- On day 11 (or 12) you have a blood test. You don't need an appointment for this (see blood tests).
- The ultrasound will take place. (You made the appointment for this on day one - remember?) (see ultrasound scans).
- Call the DPM after 4pm on day 12 for further instructions.
As of this point there are two possibilities:
- either an LH peak will be shown in your blood results, meaning that ovulation will follow, in which case you will follow the DPM's instructions precisely;
- or no LH peak will be detected. In this case the results of the ultrasound will determine what happens next:
- If the follicle is still too small (<17mm) you must plan (with the DPM) another ultrasound and prior blood test;
- If the ultrasound shows at least one and a maximum of three ripe follicles, you will need to inject the hCG that evening at the time advised. That same evening you must have sexual intercourse and the following evening too. - Between day 26 and 28, you will have a blood test to see if you are pregnant.
Follow-up of the result
Just like you, we hope that you will be pregnant. But even if you have a period in the meantime, the blood test will still take place. From the test we can determine whether a normal ovulation occurred and if the bleeding is indeed a period. This is important to know for future treatment.
facilitating implantation with progesterone (if applicable)
Depending on the situation, you may be required to place progesterone pessaries in the vagina as of the day of intercourse. Progesterone assists in the development of the endometrium (the lining of the womb) and facilitates the process of implantation of the embryo.
The pessaries must be inserted three times a day at regular intervals (8am, 4pm, 10pm) and you must continue until the DPM tell you to stop.
To prevent infections this is best done with well washed hands. There will inevitably be some moderate discharge from the vagina as a result of the pessaries, the use of sanitary towels is recommended.