Ovulation Induction

8cell_embryo2Ovulation induction is the stimulation of follicle development and subsequent ovulation by medication.  It is usually used in the sense of stimulation of the development of ovarian follicles to reverse anovulation (the absence of ovulation) or oligo-ovulation (irregular or infrequent ovulation), but can also be used in the sense of triggering oocyte release from relatively mature ovarian follicles.  The leading medication used today is clomiphene citrate (Trade names Serophene or Clomid).

When considering or taking clomiphene (Serophene or Clomid), there are four important things to keep in mind:

Clomiphene is a drug to induce follicle development with the purpose of subsequent ovulation. Therefore, additional steps should be taken to monitor whether ovulation is actually taking place.  Once an ovulatory dose of clomiphene is documented, higher doses are not recommended or practical.  Higher doses can have adverse effects on cervical mucus and the uterine lining, thus making it more difficult to conceive.  The number of attempts with clomiphene is typically three to six ovulatory cycles.  The chance of pregnancy beyond this is very minimal.  If pregnancy has not been successful after 3-6 ovulatory cycles, more advanced therapy should be considered.

How Does Clomiphene Work?

Ovulation induction is the therapy given for a condition called “Ovulation Disorder”.  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 ultimately induce the production of follicles in the ovaries. (For our explanation, they will be referred together simply 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 is a drug that “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 ultrasound and estrogen blood tests.

How Do Injectable Fertility Drugs Work?

Injectable fertility drugs have been in use for over 40 years.  They help a woman mature her own eggs with the purpose of having a pregnancy and deliver a child.  Most studies to date suggest that children conceived through the use of fertility drugs apparently 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 ultrasound and estrogen blood tests.  The ultrasound helps 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.  The monitoring helps us adjust the dose of medicine(s) to help your stimulation cycle be most effective 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 are of 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.

Fertility drug ovulation induction with insemination is successful.