Ovulation induction is the process by which the patient is given medication in order to optimize the egg production. Ovulation induction medications, also called fertility drugs, are used to stimulate the growth of the follicles in the ovary, usually resulting in the production of multiple eggs in a given menstrual cycle. These medications also allow to properly time the release of the eggs from the ovary (ovulation) in order to schedule sexual intercourse, intrauterine inseminations or in vitro fertilization at a time when you are most likely to become pregnant.
There are risks associated with the use of the ovulation inducing medications, including but not limited to an increase chance for high order multiple pregnancies and the development of ovarian cysts. A rare side effect from these medications is called ovarian hyperstimulation syndrome (OHSS) leading to symptoms such as: severe pain in the pelvis, abdomen or chest, nausea, vomiting, bloating, weight gain, electrolytes imbalances, difficulty breathing and blood clot formation.
The medications most commonly used to treat infertility include: clomiphene citrate, letrozole, gonadotropins, metformin and bromocriptine.
Clomiphene citrate (Clomid, Serophene)
is an anti-estrogen tablet used by women who have irregular menstrual periods. Clomiphene may also be used in men who have a low sperm count. Common side effects include headaches, blurred vision, hot flashes, breast tenderness and vaginal dryness.
works by a different mechanism than clomiphene by blocking an enzyme called aromatase in the ovary. It is also formulated in a tablet. Common side effects include headaches, breast tenderness, vaginal dryness, constipation and occasionally joint pains.
(Follistim, Gonal-F, Bravelle, Menopur, Repronex, Ovidrel)
are injectable medications that are used to stimulate the growth of multiple follicles in the ovary. They are also used to induce the release of the eggs from the ovary. Side effects may include: bloating, abdominal distention, mood swings and fatigue.
Metformin (Glucophage, Fortamet)
is a tablet that is used as an insulin lowering medication. This medication is commonly used in patients with polycystic ovaries (PCOS). The use of metformin may lead to a decrease in hair loss, diminished facial and body hair growth, regulation of the menstrual cycles and normal fertility.
Bromocriptine/carbegoline (Parlodel, Dostinex)
are drugs used to lower prolactin levels. They are also used to reduce the size of pituitary tumors, called prolactinomas.
There are different levels of ovulation induction therapies that are used to treat infertility caused by ovulation disorders, male factor or unexplained causes. One method of treatment consists of the use of clomiphene citrate or letrozole, which are tablets, taken for 5 days at the beginning of the menstrual cycle. For women whose only problem is lack of ovulation, about 80% of patients ovulate using these medications and 50% of patients will conceive. Both clomiphene and letrozole could be combined with intrauterine insemination to boost the success of conception by placing the sperm and egg in closer proximity of each other.
The more aggressive level of ovulation induction is the use of injectable gonadotropins. The treatment consists of daily subcutaneous injections of medications that result in the production of multiple eggs. Patients undergoing this kind of therapy are closely monitored by frequent blood draws and pelvic ultrasounds. Careful monitoring ensures that the ovaries do not hyperstimulate and allows the formation of only a few follicles in the ovaries. Thus, keeping the multiple pregnancy rates low. Once the leading follicle is about 17-20mm, a low dose of human chorionic gonadotropin (HCG) is injected to stimulate ovulation. Ovulation usually takes place 24-36 hours after the HCG injection. The patient is then instructed to either have sexual intercourse or return to the office for an intrauterine insemination (IUI). A progesterone level is usually obtained about 1 week after the HCG shot. A pregnancy test is usually done about 2 weeks from the HCG shot to confirm successful conception.