Ovulation Induction

Ovulation Induction Involves the Use of Fertility Drugs.

Fertility medications, such as FSH to stimulate the recruitment and development of one or more mature follicles in the ovaries. Women with ovulatory dysfunction (irregular or even absent menstrual cycles) will benefit from the use of fertility drugs to induce ovulation.  Furthermore, couples with unexplained infertility may undergo treatment with a form of ovulation induction called ‘controlled ovarian hyperstimulation  in conjunction with either intrauterine insemination (IUI) or in vitro fertilization (IVF). Ovulation induction cycles should be administered and monitored by a trained fertility specialist.

Controlled ovarian hyperstimulation involves the use of fertility drugs to intentionally stimulate the development of multiple mature follicles and eggs in order to increase the chances of pregnancy because there will be ‘more eggs’ available for possible conception.  In IVF and donor egg cycles, the recruitment and maturation of multiple eggs is desired so there will be multiple embryos made for possible embryo transfer.  Even in fertile women, not every egg is capable of fertilizing normally, and not every embryo will continue to grow and divide normally.

Fertility drugs used include oral drugs such as Clomid or letrozole (Femara) as well as injectable gonadotropins (FSH).  In some patients, both Clomid and injectable medications are used. Gonadotropins are hormones that are naturally synthesized and released by the pituitary gland, a small gland located at the base of the brain.  The pituitary gland produces two different types of gonadotropins known as luteinizing hormone (LH) and follicle stimulating hormone (FSH), both acting in a synchronized pattern to recruit follicles and lead to the development of mature eggs.

There are several commercially prepared fertility drugs (Gonal-F, Follistim, Menopur, Bravelle, Repronex) that are collectively known as “gonadotropins” because they contain human FSH with or without LH.  Monitoring response from fertility medications will depend on the type of medications used, and if ovulation induction is being given in the context of an IUI or IVF cycle.  This includes ultrasound as well as blood testing for estradiol and/or progesterone levels at our Dallas, TX IVF fertility clinic location. Details are given in the specific pages dedicated to IUI or IVF.

One of the risks from ovulation induction and controlled ovarian hyperstimulation is that of multiple gestations. Even in carefully monitored cycles, there is incomplete control over how many eggs are ovulated.  Our goal is to balance the benefit of increased chance of pregnancy with the risk of multiples (twins, triplets, etc.). The degree of risk depends on the type of medications used, a woman’s response to the fertility medications, as well as the type of fertility treatment used (IUI, IVF). When gonadotropins (given by injection) are used, the risk of twins is increased to approximately 15-20%. These drugs should always be administered by a trained fertility specialist.