Ovulation Induction

For people who are not ovulating regularly, the goal of treatment is to mature and ovulate a single egg — this is known as ovulation induction.

About 50 percent of treatment cycles performed at Shady Grove Fertility include ovulation induction and intrauterine insemination (IUI) — basic treatments requiring less medication and fewer monitoring appointments with a lower cost.

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Ovulation induction process

Clomiphene citrate (Clomid, Serophene) is a commonly used ovulation induction medication. It is used primarily to treat women who have ovulation disorders as reflected by infrequent or irregular menstrual cycles. Approximately 80 percent of women taking clomiphene citrate will successfully ovulate, but fewer than 50 percent of patients will conceive.

Though clomiphene citrate is generally well tolerated, it can cause hot flashes and mood changes as well as lead to cervical mucus changes and thinning of the uterine lining that can negatively impact success rates. Another risk to consider is the increased chance of multiples — which is around 10 percent — compared to the natural rate of twinning, which is between 1 to 2 percent.

Step 1A: Ovarian stimulation | Medications

The main goal of this phase is to induce ovulation with common medications like Clomiphene citrate (Clomid, Serophene). Clomid facilitates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which stimulates the ovaries to produce eggs and the ovarian hormones estradiol (E2) and progesterone (P4). Patients can expect to orally take Clomid for 5 to 7 days typically starting on day 3 of a their menstrual cycle. It’s best to take the medications daily at bedtime, or as instructed by the physician. Additionally, the physician may prescribe an Ovidrel injection to trigger the egg release.

Step 1B: Ovarian stimulation | Monitoring

The physician will monitor egg development with E2 and LH hormone tests and ultrasound scans of the ovaries to determine when the eggs are mature. Increased levels of estrogen are a good indicator of follicular development. Additionally, ultrasounds help physicians see the thickness of the uterine lining and ovaries and the number of follicles within them.

Step 2: Timed intercourse, if applicable

If the patient is taking the timed intercourse treatment path, intercourse is instructed on the day of the trigger shot and then again 2 days later to increase potential chances for conception.

FAQs

You can easily obtain clomiphene citrate that your physician prescribed at most local pharmacies, whether they specialize in fertility medications or not.

Monitoring appointments consist of an ultrasound and bloodwork. The ultrasound allows the physician to visualize the thickness of the uterine lining and the ovaries, more specifically the number of follicles within them. The bloodwork shows the trend of pre- to post-stimulation hormone levels—increased levels of estrogen indicate follicular development. These two measures of cycle progress tell your physician about three important events during stimulation:

The first thing a physician learns from monitoring the progress of the cycle is if a follicle was recruited and developed. Finding the correct dosage that results in developing a single follicle in the beginning is a bit of guess and check. Some women will respond to a 25 mg dose, while others can require up to 150 mg before follicular development starts to occur. Starting with a conservative dose until the physician knows how you will respond is the best approach, as over-stimulation can result in the development of more than one follicle and, as a result, an increased risk of multiples.

So what if it doesn’t work? Lack of response indicates to the physician that you need a higher dosage of medication. This higher dose can start the same day since you are still in the follicular phase of your cycle. The ability to know that the dosage was ineffective early in the treatment cycle saves you nearly an entire month.

The second factor that monitoring can tell a physician is how the uterine lining responded to the clomiphene citrate. Some women using clomiphene citrate will suffer from a thinning of the uterine lining, making for a less than optimal environment for embryo implantation. Should this occur, physicians can help to supplement the thickening of the lining with an estrogen suppository. In some cases a follicle will develop, but pregnancy may not have occurred because the lining was too thin—a factor that the physician wouldn’t be aware of without an ultrasound-monitored cycle.

Unmonitored cycles can result in an increased chance of multiples, which is risky for both mother and babies. Multiples can occur when several follicles are developed and ovulated in a single cycle. Monitoring can tell the physician when an unsafe number of follicles have been developed, allowing him or her to advise you to abstain from intercourse to avoid the increased risk of a higher- order pregnancy.

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