Ovulation Induction

Ovulation induction uses hormonal therapy to stimulate egg development and release. Historically, the use of agents to induce ovulation (egg development and release) were designed to induce ovulation in women, who themselves, did not ovulate; typically women with irregular menstrual cycles. The goal of this treatment was to produce a single, healthy egg. The second use of ovulation induction was to increase the number of eggs reaching maturity in a single cycle to increase chances for conception. The initial agents for this treatment (used first for In vitro Fertilization (IVF) and only later for simpler treatments) were injectable medications. These agents carry an increased risk of multiple gestation, ovarian hyperstimulation, and increased cost and time commitment. More recently, in the mid-90s, evidence developed to suggest there may be an advantage to treating even ovulatory women with fertility medications. These women with "unexplained infertility" may have subtle defects in ovulation and the use of medications may induce the maturity of 2-3 eggs versus only one. This treatment therefore improves the quality and quantity of the ovulation, thus enhancing pregnancy rates. Ovulation induction, in ovulatory women, is always combined with intrauterine insemination. Ovulation induction should only progress after a complete and thorough evaluation. All underlying hormonal disorders (such as thyroid dysfunction) should be treated prior to resorting to ovulation induction with fertility drugs.

Common Fertility Drugs used for Ovulation Induction 

Clomiphene Citrate (Seraphene, Clomid)

Clomiphene citrate is an oral medication that induces ovulation by blocking estrogen receptors. This artificial anti-estrogen effect causes your body to believe estrogen is low and therefore cause the production of more FSH. Clomiphene citrate acts as a fertility agent in women by inducing superovulation, i.e. the release of multiple eggs in a given menstrual cycle. Some form of monitoring is necessary while taking clomiphene citrate. This monitoring may include ultrasounds, blood estrogen levels, and/or urinary LH testing. Clomiphene citrate, for unexplained infertility is prescribed with intrauterine insemination (IUI). When used for ovulation induction in women who do not ovulate, IUI is not necessary.

HMG

  • LH/FSH (Letrozole, Repronex, Menopur)
  • Human Menopausal Gonadotropin (hMG)

HMG is a medication that is composed of FSH, with LH, and is used for stimulation of egg development in women who do not ovulate spontaneously, who ovulate extremely irregularly, or to increase the number of eggs developed in a single cycle in women who already ovulate. Due to the variability in response from patient to patient no fixed dosage regimen can be recommended. Each patient and cycle must be individualized, however, it is generally thought to be a stronger superovulation agent than oral medications. Some form of monitoring of the ovarian response is necessary; a combination of blood estrogen measurement (E2) and ultrasound is the best approach at the present time. This fertility medication can be used with both intrauterine insemination (IUI) and in vitro fertilization (IVF). hMG is available only in an injectable form. Self-administered injection techniques are taught in a special injection instruction class given by the nursing staff at the UCSF Center for Reproductive Health. Monitoring, with ultrasounds and estradiol levels, minimizes the risk of complications.

FSH (Follistim/Gonal F, Bravelle)

FSH medications are used to stimulate the recruitment and development of multiple eggs in women during an ovulation induction cycle. FSH products may be used alone or in combination with hMG to induce superovulation. Due to the variability in response from patient to patient, no fixed dosage regimen can be recommended. Each patient cycle must be individualized and requires ultrasound exams and blood estrogen levels to assess ovarian response. FSH is available only in an injectable form. Self-administered injection techniques are taught in a special injection instruction class given by the nursing staff at the UCSF Center for Reproductive Health. Monitoring with ultrasounds and estradiol minimizes the risk of complications.

HCG (Profasi or Pregnyl or Ovidrel)

Human Chorionic Gonadotropin HCG is a natural hormone that helps with the final maturation of the eggs and triggers the ovaries to release the mature eggs (ovulation). It also stimulates the corpus luteum to secrete progesterone to prepare the lining of the uterus for implantation of the fertilized egg. Ovulation (follicle rupture) usually occurs about 36 hours after the hCG is given. It is self-administered as an injection. Self-administered injection techniques are taught in a special injection instruction class given by the nursing staff at the UCSF Center for Reproductive Health.

Leuprolide (Lupron)

Synthetic Gonadotropin (FSH/LH) Inhibitor Lupron suppresses the brain's secretion of LH and FSH; therefore, it is used in preparation for cycles of treatment with ovulation induction drugs (exogenous hMG-LH/FSH and or FSH). It improves the recruitment of follicles by preventing the recruitment of a dominant follicle for the next menstrual cycle. Lupron enables the ovaries to respond with the recruitment of multiple follicles since in most cases it is possible to override the selection of a single dominant follicle. It also prevents premature ovulation (release of eggs) by preventing LH release. To confirm the effectiveness of the Lupron treatment, an ultrasound is performed before the ovarian stimulation is begun and a blood estrogen level (E2) may be required. Lupron may also be utilized to stimulate FSH if it is used early in the menstrual cycle. This property of the drug is helpful in patients expected to respond poorly. Lupron is available in an injectable form. Self-administered injection techniques are taught in a special injection instruction class given by the nursing staff at the UCSF Center for Reproductive Health.