When a woman is facing anovulation (the absence of ovulation) or oligo-ovulation (irregular or infrequent ovulation), ovulation induction treatments are often used to stimulate ovarian follicle development and subsequently ovulate by medication. Ovulation induction can also be used to trigger oocyte release from mature ovarian follicles.
The leading medication used today is clomiphene citrate, which goes by the trade names Serophene or Clomid.
When considering or taking Clomiphene (Serophene or Clomid), there are important factors to keep in mind:
- Careful monitoring should be maintained to determine when ovulation actually takes place.
- Once ovulation has occurred, higher doses are not recommended as they can have adverse effects on cervical mucus and the uterine lining.
- Typically, the use of clomiphene is attempted for three to six ovulatory cycles. Afterwards, women should consider more advanced therapy.
How does clomiphene work?
Ovulation requires a delicate balance of hormones. It takes place when there is a proper regulation of the hormones FSH and LH; these are reproductive hormones in the “hypothalamic-pituitary-ovarian axis.” The hypothalamus and pituitary are next door neighbors in the brain and work together to induce the production of follicles in the ovaries. (For the purpose of our explanation, together, they will be referred as the “brain.”)
The brain monitors how much estrogen is in the body. If it is low, it sends FSH to the ovaries, which helps them develop a follicle, and the follicle in turn, secretes estrogen. Once there is sufficient estrogen in the body, the brain assumes there is a follicle that is ready to release an egg (ovulate). To cause this follicle to rupture and release its egg, the brain sends out a hormone signal into the blood, and this hormone is called LH.
Clomiphene “fools” the brain into thinking that estrogen levels are low. As a result, the brain releases more FSH than it normally would to stimulate the ovaries to develop a follicle. If clomiphene doesn’t work, the next level of therapy involves injectable fertility drugs which actually contain FSH. If the brain won’t make FSH in adequate supplies, we simply inject FSH into the system and carefully monitor the body’s reaction with ultrasounds and estrogen blood tests.
How do injectable fertility drugs work?
Injectable fertility drugs have been in use for over 40 years and help a woman mature her own eggs. Most studies to date suggest that children conceived through the use of fertility drugs have no greater risk of birth defects than in the general population.
This therapy involves daily injections for about 10 days. After several days of injections, we begin to monitor the body’s response to the drugs with ultrasounds and estrogen blood tests. The ultrasounds help us see how many follicles are developing and how big (mature) they are getting. The estrogen tests give us an indication of the rate of response to the drugs. Overall, the monitoring helps us adjust the dose of medicine(s) to help achieve the most effective stimulation cycle, while minimizing the side effects and risk for multiple births.
Multiple births occur about 20% to 25% of the time. To obtain more information about results for IVF, see www.sart.org. The vast majority of multiple births result in twins. Higher-order, multiple births (defined as more than twins) can be significantly minimized when you are properly monitored by an experienced team of experts.
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