Ovulation Induction at Boca Fertility

What is ovulation induction?

For those who do not ovulate regularly, such as those with irregular cycles, polycystic ovary syndrome (PCOS) and other infertility issues, ovulation induction is often the first line of treatment. It is one of the most simple fertility treatments and is relatively low cost. 

It works to stimulate the ovaries to produce one or more eggs and can either be used to increase a woman’s chance of conceiving a child through sexual intercourse, using intrauterine insemination (IUI) or another fertility treatment like in vitro fertilization (IVF).

Who can benefit from ovulation induction?

Our fertility specialists will work closely with you to determine whether ovulation induction is the right treatment for you. Here are some common indications for using medication to induce ovulation:

• Individuals with irregular menstrual cycles.
• Those diagnosed with polycystic ovary syndrome (PCOS).
• Women experiencing unexplained infertility.
• Those preparing for certain fertility treatments like IUI.

How does ovulation induction work?

Oral Medication: Clomiphene or Letrozole

The first step is to induce ovulation using an oral medication. The medication increases pituitary production of FSH (Follicle Stimulating Hormone), which stimulates the growth of eggs within the ovary until they mature and advance to ovulation. You can expect to take your medication (letrozole or clomid) for 5-7 days starting on the 3rd day of your menses.

Injection: Gonadotropin Therapy

If you fail to ovulate with Clomiphene, your fertility specialist may prescribe hormone injections, such as Gonadotropin therapy. 

Monitoring

Your fertility specialist and coach will monitor you closely through hormone tests and ultrasounds to determine when the follicles are mature. 

Trigger Shot

Once the follicles have reached maturity, an HCG injection, or “trigger shot”  is often used to trigger ovulation and boost progesterone production. If you are planning on conceiving naturally, intercourse is recommended on the day of the trigger shot and for two days after. We recommend scheduling IUI within two days of the trigger shot. 

How successful is ovulation induction?

The success of ovulation induction largely depends on the cause of the ovulation problem, age, the medications used, and any other underlying fertility issues that might be present. In general, Clomiphene has ovulation rates ranging from 60% to 85% per cycle, but ovulation does not guarantee pregnancy. For patients taking oral medication, pregnancy rates range from 5-12%, which can go as high as 20% with the help of Gonadotropin injections. It is important to note that Gonadotropin injections greatly increase the risk of twins and higher order multiples which increases risks of pregnancy complications.

What are the risks and complications of ovulation induction?

For most, ovulation induction is a simple, straightforward process, but all medical treatments have risks. The main risks are: 

• Ovarian enlargement as a result of the development of multiple follicles may occur although severe Ovarian Hyperstimulation Syndrome (OHSS) is extremely rare.
• Multiple pregnancies (mostly twins) occur in 7-8% of patients.
• About 10% of the patients may experience hot flashes from the fertility medication while abdominal swelling, breast tenderness, nausea, headaches and visual symptoms are infrequent.
• Poor response

Commonly Used Fertility Medications

Clomiphene Citrate

Clomiphene Citrate tablet brands are taken by mouth usually at a dose of 50 mg daily for 5 days between days 5-9 of your menstrual cycle. In patients with shorter cycles the medication is sometimes started earlier on day 3 of cycle.

Letrozole

Letrozole, a widely used fertility medication, plays a crucial role in ovulation induction for individuals facing challenges in achieving pregnancy. It belongs to a class of drugs known as aromatase inhibitors, primarily used in breast cancer treatment. However, in the context of fertility, Letrozole serves to stimulate ovulation by suppressing the production of estrogen and promoting the release of follicle-stimulating hormone (FSH) from the pituitary gland. This FSH surge encourages the growth and maturation of ovarian follicles, eventually leading to the release of a mature egg during ovulation. Letrozole’s mechanism of action offers a promising solution for women with ovulatory disorders, contributing to their fertility journey by increasing the likelihood of successful conception.

Gonadotropin Injections

Injectable Gonadotropin pens are given to help a woman produce and release healthy eggs when ovulation is a problem or to stimulate the ovaries to produce multiple eggs during Vitro Fertilization (IVF). You must be closely monitored by an experienced fertility specialist. throughout the treatment.

Conventional Gonadotropin injections are potent hormone injections contain FSH and LH and must be closely supervised by a fertility specialist.

HCG “Trigger”

This HCG medication given to “trigger” ovulation when ultrasound shows that the largest (dominant) follicle is between 16-20 mm. The medication is sometimes utilized to maintain adequate progesterone production from the ovary after ovulation.

Progesterone Preparations

The medications can be given in the form of vaginal tablets, vaginal suppositories or injections and are utilized to maintain optimal progesterone levels after ovulation and through the first 12 weeks of pregnancy.

GnRH Medications

GnRH agonists are used to suppress pituitary function during IVF and in the treatment of endometriosis or uterine fibroids. During IVF it is important to prevent your own trigger to ovulation. They can be given beginning a week before your menses (long protocol). They can also be given together with the gonadotropin injections beginning on day 2-3 of cycle (micro-dose or short protocol). GnRH antagonists such as Ganirelix or Cetrotide are given daily, beginning on day 6 of gonadotropin injections.