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Ovulation induction (fertility medications)
Ovulation induction involves the administration of medications--either orally, by injection, or by a combination of both--to stimulate ovarian follicle development. Medications must be administered daily over the course of seven to 10 days, so patients are taught to administer their own daily injections. The injections are given with a very small needle just under the skin, and it's hard to get them wrong. (This is the same way people with diabetes give themselves insulin injections.)
Ovulation induction can be performed to produce eggs so the couple can conceive through intercourse or insemination, or as a first step for IVF, to produce eggs that will be removed from the ovaries to be fertilized in the lab.
The most commonly used oral medication is clomiphene citrate (Clomid). The drug is taken for five days starting day three, four, or five of the menstrual cycle. Some other drugs may also be used. Injectable medications, most of which are the human hormone FSH, are usually taken for about seven to 10 days starting on day three of the cycle.
The woman will probably have to visit the clinic several times for ultrasounds or blood tests to monitor her ovaries and hormone levels and determine if the doses of the medications need to be adjusted. Patient response to medications is highly variable and can even vary one month to the next, so frequent and careful monitoring during treatment is critical. The doses of these medications also depend on whether you are trying to produce many eggs to use in IVF or just a few for insemination or timed intercourse.
Your doctor may want you to take progesterone supplements while you are using fertility medications to help prepare the uterine lining for pregnancy. The progesterone supplements are usually continued for a few weeks if the pregnancy test is positive. When ovulation induction is done for IVF, progesterone supplements are usually required because of additional drugs that are given to prevent early ovulation.
For IVF, it is very important that women do not ovulate early. If the ovaries release the eggs even one minute before the doctor goes in to retrieve the eggs, the whole cycle is lost. So when ovulation induction is done for IVF, you may have to take another medication (in addition to the fertility drugs and progesterone) that prevents early ovulation. The medication is either a GnRH agonist or GnRH antagonist, given as an injection.
For insemination or timed intercourse, when the doctor decides the ovaries are ready, an additional injection is given to trigger ovulation, followed by either insemination or timed intercourse.
The most important danger of ovulation induction is that too many follicles will develop. This can lead to a rare but serious condition called ovarian hyperstimulation syndrome, which is covered on the next page. If ovulation induction is to be followed by intrauterine insemination or timed intercourse, then having too many follicles could lead to a multiple pregnancy. Being pregnant with more than twins (called "high-order multiple gestations") is risky for the woman and the babies. To prevent these potential problems, treatment is usually canceled if too many follicles are developing.
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