Ovulation Induction
Ovulation induction is used to treat infertility caused by anovulation or oligoovulation. Medications are used in a step-wise fashion to induce ovulation while limiting side effects and complications.
Diagnosis
Prior to ovulation, diagnostic tests are utilized to define the cause of the problem. These tests may include:
- Basal body temperature charts
- Ultrasound
- Ovulation predictor urine tests
- Progesterone levels
- Endometrial biopsy
It is also necessary to rule out other causes of ovulatory problems by testing for thyroid, pituitary, or adrenal dysfunction. These glands are tested by a single blood sample on which hormonal tests can be run (TSH, Prolactin, DHEA-S). Other causes of ovulatory dysfunction that might be evaluated include polycystic ovary syndrome, ovarian failure, or hypothalamic dysfunction.
Treatment
Ovulation induction involves treating any underlying disorders (PCOS, hypothyroidism, and hyperprolactinemia) and/or using ovulation inducing medications.
Oral medications for ovulation induction include clomiphene citrate (Clomid, Serophene) or letrozole (Femara). These pills are taking for five days at the beginning of the menstrual cycle and cause ovulation in approximately 70% of anovulatory women.
Clomiphene citrate or letrozole may be combined with gonadotropin, injectible medications, to cause ovulation. These protocols are utilized when a woman does not ovulate on the pills alone, or ovulates but does not conceive and all the other tests (semen analysis, hysterosalpingogram, and ultrasound) are normal.
Superovulation cycles utilize only injectable gonadotropin. These cycles have the greatest change of causing ovulation, and pregnancy. They also cause the greatest chance of twins, or higher order multiples. Because these medications have these risks, women will undergo more frequent monitoring with ultrasound and blood, than during other ovulation induction protocols.
Often, ovulation induction is used in conjunction with other treatments, such as Intrauterine Insemination (IUI) to improve the chance of conceiving.