Ovulation Induction

Ovulation induction overview

  • Ovulation induction is the use of medication to cause a woman’s ovarian follicles to develop and release eggs (ovulate).
  • Ovulation induction is often used for women experiencing anovulation, polycystic ovary syndrome (PCOS) and infertility.
  • Problems with ovulation are a major cause of infertility in women.
  • Ovulation induction is a cost effective and less invasive way for women experiencing ovulation-related infertility to conceive via sexual intercourse or intrauterine insemination (IUI).

What is ovulation induction?

Ovulation induction medically causes ovulation in order to reverse certain ovulation disorders or increase a woman’s chance of conceiving, either through sexual intercourse or through artificial insemination via intrauterine insemination (IUI). About 25 percent of women with infertility have problems with ovulation.

Ovulation induction can help women who do not ovulate, women who do not release the eggs they do ovulate, or those who do ovulate but it doesn’t result in pregnancy. Ovulation inducing medications can also increase the number of mature eggs for use with in vitro fertilization (IVF) treatments.

The hormone-based medications clomiphene citrate, letrozole and gonadotrophins are sometimes referred to as fertility drugs and are the most commonly used medications for ovulation induction.

Ovulation induction medications include:

  • Clomiphene citrate (Clomid and Serophene) is taken orally for a short period and stimulates ovulation by blocking estrogen receptors. This causes the body to overcompensate for the perceived deficiency and increase production of the follicle-stimulating hormone (FSH) vital to proper ovulation. This medication causes ovulation in 60-80 percent of women, with about 50 percent of those becoming pregnant.
  • Aromatase inhibitors (AI), such as letrozole, prevent hormones from changing into estrogen. Letrozole has recently been shown to be very effective in treating ovulation disorders due to PCOS.
  • Insulin-sensitizing agents (ISA), such as the drug metformin (Glucophage), promote growth of follicles that are important to ovulation by lowering estrogen and androgen levels.
  • Women with ovulation problems may need some form of gonadotropins, which are injectable medications that may be used alone or in conjunction with oral medications. Women receiving injectable drugs will need more frequent monitoring due to increased risks (see below).

Who should consider ovulation induction?

Women who are having trouble achieving pregnancy due to anovulation or PCOS, which inhibits ovulation, may benefit greatly from ovulation induction. In most cases of anovulation, a dose of clomiphene citrate or letrozole will cause ovulation and allow a couple to conceive through sexual intercourse or IUI.

Before inducing ovulation, physicians try to diagnose the reason for lack of ovulation. Treatment often depends on the cause. Ovulation induction may be a good option for:

  • Women with PCOS, a common condition that inhibits ovulation; letrozole or the insulin reducing medication metformin may help control weight gain, facial and body hair growth and high blood pressure, all common symptoms of PCOS.
  • Women with inadequate production of lutenizing hormone (LH) or FSH
  • Women with eating disorders, thyroid conditions or obesity, all of which can affect reproductive hormones involved in ovulation.

For women who are experiencing additional difficulties with ovulation, the doctor can induce superovulation with human choronic gonadotrophin (hCG) or with a combination of clomiphene and hCG. The hormone hCG is used to stimulate the release of the egg during ovulation.

Superovulation stimulates the production of multiple eggs to be released, sometimes resulting in the birth of multiples (twins, triplets). Physicians use blood tests and ultrasounds to closely monitor women who undergo superovulation treatments.

What are the risks of ovulation induction?

Injectable ovulation inducing medications can sometimes cause ovarian hyperstimulation syndrome (OHSS). OHSS symptoms are classified as mild, moderate or severe and often subside on their own after a couple of weeks.

Side effects of OHSS and possible side effects from using ovulation induction medications include:

  • Bloating
  • Nausea
  • Pelvic tenderness
  • Shortness of breath
  • Hot flashes
  • Headache
  • Blurry vision
  • Weight gain.

Ovulation stimulation, specifically superovulation, can cause the production of multiple eggs. This increases a woman’s chance of becoming pregnant with multiples, making the pregnancy more high risk for her and her children.

What are the benefits of ovulation induction?

Ovulation induction is one of the most cost effective and least invasive ways to achieve pregnancy for women experiencing ovulation-related infertility. It also improves the outcome of patients receiving IVF or other fertility treatments.

It is often one of the first steps toward helping couples experiencing infertility to conceive. Ovulation induction can be used in conjunction with holistic fertility treatments to further increase the chances of pregnancy.