What is Ovulation Induction?
After the initial infertility evaluation, if there is no visible evidence of tubal disease, severe endometriosis, or severe male factor, ovulation induction is often offered as the first treatment for infertility, especially when the woman does not have regular periods.
Ovulation induction is a fertility treatment that involves the woman taking medications to optimize ovulation or to increase the number of eggs to improve the probability of pregnancy. There are two types of medication available for ovulation induction: oral and injectable.
Oral medicines work by helping to stimulate the release of FSH from the pituitary gland, which encourages the development of the egg.
Also known as Clomid or Serophene, this drug blocks the brain’s estrogen receptor and causes the mind to believe that the body is not producing enough estrogen. This perception causes the pituitary to increase the release of FSH to stimulate the ovaries to produce eggs.
Facts about clomiphene:
- It causes ovulation in 80 percent of the users.
- It gives only a 10 – 15 percent chance of live birth per cycle even with intrauterine insemination (IUI).
- Side effects may include hot flashes and a 10% risk of multiple pregnancies.
- Clomiphene can interfere with the binding of estrogen to the uterine lining (endometrium). Because the lining needs estrogen to grow, prolonged use can result in the thinning of this lining, which can lead to a decrease chance of embryo implantation. Pregnancy rarely occurs when the endometrium is less than 6 mm thick.
Also known as Femara, is a newer drug that was initially created to help women with estrogen-sensitive breast cancers from having a recurrence. Letrozole blocks the production of estrogen that is necessary for breast cancer cells to grow. Similar to clomiphene, letrozole causes the pituitary to release FSH, which stimulates the ovaries. Fertility specialists also use this medication to induce ovulation.
Facts about Letrozole:
- Letrozole does not interfere with estrogen binding to the endometrium, so it does not affect the uterine lining growth.
- Side effects may include hot flashes and a 5 percent risk of multiple pregnancies.
- There is a live birth rate of 10 percent per cycle.
What to Expect: Treatment Cycle for Oral Medications
- A typical cycle will begin with ultrasound and blood work on the third day of your menstrual cycle.
- You will take the medications between days three and seven or days five and nine of your cycle.
- On day twelve, a transvaginal ultrasound will be performed to check for follicular development.
- Once the dominant follicle reaches a mature size, an injection of hCG (human chorionic gonadotropin) can be used to assure that ovulation will occur. If your treatment includes IUI, your doctor may perform the procedure one to two days after your hCG injection.
Injectable medicines are more potent than oral medications and are usually prescribed if oral medications have not worked. These therapies are used to stimulate the ovaries to make multiple eggs. The medications are a combination of FSH and LH, hormones normally produced by the pituitary gland to stimulate egg development.
The medications used are FSH (Follistim, Gonal-f), and a combination of FSH & LH (Menopur).
Facts about gonadotropins:
- It can be expensive, ranging from $2,200 – $2,500 per cycle.
- Close monitoring by several sonograms and blood work is necessary to avoid certain risks such as hyperstimulation and multiple gestations (30% of pregnancies).
- Pregnancy rates are increased to about 25%.
- For best results, cycles should be combined with IUI.
What to Expect: Treatment Cycle for Injectable Medications
- The cycle will begin with ultrasound and blood work on the third day of your menstrual cycle.
- You will start the medications on day three and continue for six to 10 days, depending on the response.
- During this time, you will have three to four ultrasounds and blood work to monitor follicle development.
- After each visit for your ultrasound and blood work, you will be contacted by the nurse with instructions.
- Once the lead follicle(s) reaches the required diameter, you will use an injection of hCG to trigger ovulation.
- Intrauterine insemination can be performed within the next two days to achieve pregnancy.
If you are struggling to conceive, it can be a stressful time. Seeking medical assistance can not only help relieve some of the stress that you and your partner are experiencing, but it can also facilitate the realization of your dreams of having a baby. To find out more about ovulation induction or other fertility treatments, please contact our office today for a consultation. We would love to speak with you about how we can help to make your dream a reality.