When medications are used to stimulate the development of many eggs, it is called ovulation induction. The medication cause development of many mature follicles in the ovaries, which is the sacs where eggs develop. Women who do not ovulate, or those who do not ovulate irregularly, benefit from ovulation induction.
Ovarian hyperstimulation, which occurs with ovulation induction, involves the use of ovulation inducing medications to stimulate the development of many mature follicles and eggs. This produces increased pregnancy rates.
Candidates for Ovulation Induction
Ovulation induction is used for women with polycystic ovarian syndrome (PCOS). This is a condition where women have increased levels of androgen hormones, which produce excessive body hair, cause irregular menstrual cycles, and lead to infertility. Other candidates for ovulation induction are:
Women with unexplained infertility.
Women who are not spontaneously ovulating.
Women with irregular, long, or infrequent cycles.
Couples with no male factor infertility.
Certain people will not benefit from ovulation induction and are not considered good candidates for the therapy. These include:
Women with severe tubal damage or blockages.
Women over 38 years of age.
Women with severe endometriosis.
Couples where infertility is related to low sperm count or poor sperm quality.
Clomiphene Citrate (Clomid and Serophene)
These oral drugs are taken on days 5-9 of the menstrual cycle. Around 89% of women will ovulate using Clomid, and approximately 40% of women get pregnant taking this drug. Ovulation typically occurs after a week of therapy. A total cycle may be 35 days long. Documentation is documented using a 21-day progesterone blood test, urine ovulation predictor kits, and basal body temperature charts. Common side effects associated with Clomid are hot flashes, headaches, and blurred vision.
This drug is an oral medication that reduces insulin resistance and improves ovulation for women with polycystic ovaries. Given to patients with PCOS, this drug is known to decrease hair growth on the face and body, regulate menses, and normalize blood pressure.
Injectable fertility medications that contain follicle-stimulating hormone (FSH) are called gonadotropins. These medicines cause the development of multiple follicles when injected into women who do not ovulate. Approximately 90% of women can have ovulation induced using gonadotropins. Pregnancy rates for these medicines are better than those for Clomid. Around 15% of women taking gonadotropins achieve pregnancy when this treatment is combined with intrauterine insemination (IUI).
The injections are started after onset of menses, and they are continued for around 8-12 days, until an ultrasound confirms mature follicles of the ovaries. At this time, an injection of human chorionic gonadotropin (hCG) is given to cause release of eggs 34-36 hours later. Gonadotropin therapy is usually tried for around 3-6 months. If pregnancy doesn’t result after that timeframe, the fertility specialist recommends in vitro fertilization. The cost of gonadotropin injections range from $50 per day to more than $300 per day.
Monitoring using blood tests and ultrasound is essential when ovulation induction medications are used. This monitoring is done 2-3 times a week during the time the woman takes the medications. The main complication associated with these medications is ovarian hyperstimulation syndrome (OHSS), which is rare. With hyperstimulation, symptoms are enlarged ovaries, abdominal pain, and fluid build-up of the abdomen. Another risk associated with gonadotropins is multiple pregnancy. Approximately 20% of all pregnancies result in twins, and another 5% results in triplets.