 Ovulation problems are responsible for about 20 percent of all infertility conditions. Disorder of ovulation can be detected in several ways. Sometimes a woman has no menses at all (amenorrhea). At other times she may ovulate sporadically decreasing her chances for pregnancy. If ovulation dysfunction is the only infertility factor, treatment with clomiphene citrate (Clomid, Serophene) can restore normal ovulation in about 80% of the patients. And of those that do ovulate, about 50% will conceive after three cycles of treatment. Side effects attributed to the medication occur in less than 10% of patients and include hot flushes, breast tenderness, and abdominal pain as a result of enlargement of the ovaries. There is also increased incidence of twins (7%) because more than one egg can be released. |
 In some women the problem with ovulation can be attributed to Polycystic Ovary Disease (PCOS) characterized by irregular cycles, obesity and increased male hormone levels. Here, adding an Insulin blocker (Metformin) can improve the quality of ovulation, increasing the pregnancy rate and decreasing the rate of miscarriage. |
 When treatment with Clomiphene Citrate fails to restore ovulation, you may be considered for
Gonadotropin therapy. With this treatment expect to receive daily injections of fertility medication for about 10 days. During the treatment you will have several ultrasounds to check on the developing eggs and to make sure that the lining of the uterus is thick enough to support a pregnancy. In addition several blood tests for Estradiol will be performed so that the dose of the fertility medication can be adjusted to prevent too many eggs from developing, since this may increase the risk of multiple pregnancies. |
 Once the eggs reach a size of about 20 mm. by ultrasound an HCG shot will be given to trigger the ovulation. Insemination with your husband’s sperm will be scheduled at the time of ovulation to maximize the number of sperm reaching the egg, increasing the likelihood for pregnancy. |
 The pregnancy rates from this treatment range between 40-90% after six treatment cycles depending on the cause of the ovulation problem.
The major complications of this therapy include Hyperstimulation Syndrome occurring in about 1% of the patients.  Careful monitoring of the developing eggs by ultrasound and blood tests can minimize the risk of this condition and decrease the risk of multiple pregnancies to about 10%. When a triplet or higher order pregnancy occurs, some patients may elect to reduce the pregnancy to twins (Multifetal Pregnancy Reduction). |
 Sometimes the problem with ovulation can be traced to a high level of a pituitaryhormone called Prolactin. This condition can be treated with Parlodel. In other patients the ovulatory disorder may be caused by stress or by abnormal thyroid hormones. An underactive thyroid can be treated with thyroid hormone such as Synthroid The important thing is that once your doctor identifies the cause for the ovulation problem, proper treatment can result in an excellent pregnancy rate. |
| In older women, problems with ovulation may result from normal” aging” of their eggs. And when their eggs are depleted, they stop having periods altogether (menopause). Other women may experience menopause at younger age (Premature Ovarian Failure). In these situations, In Vitro Fertilization (IVF) with donated eggs from younger women may be their only recourse. The status of the ovaries can be determined by a blood test for Follicle Stimulating Hormone (FSH), inhibin and Estradiol done on day 3 of the menstrual cycle. Delivery rates for donor egg IVF exceed 50%. |
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