Ovulation Induction

During a normal menstrual cycle, a woman's body usually only produces one mature follicle that results in the ovulation of a single oocyte or egg. For women struggling with fertility and undergoing treatment, Ovulation Induction uses medication to increase the number of eggs released per cycle, which can and may improve your chances of becoming pregnant.

Patients taking these medications can expect to be monitored closely over the course of the treatment over a 2 – 3 week period to determine their response to the treatment. Based on your results, your doctor will adjust the dosage as necessary, and inform you of the optimal time for intercourse or intrauterine insemination.

At First Step Fertility, we use several medications, including Clomiphene Citrate and Injectable Gonadotropins.

Clomiphene Citrate, offered in pill form, is given to women who do not ovulate regularly but wish more than one egg to mature each month. It is generally prescribed to be taken over a period of 5 days, during the early part of the menstrual cycle. Clomiphene Citrate causes the release of more follicle stimulating hormone (FSH) by stimulating the pituitary gland. In the ideal situation, increased levels of FSH will result in maturation of a follicle or follicles, which will lead to ovulation.

Side effects associated with Clomiphene Citrate include:
  •  Headaches • Nausea • Hot flashes • Blurry vision • Mood swings

Some patients taking Clomiphene Citrate develop a thin endometrial lining which may make it more difficult for the patient to become pregnant.

Multiple gestation (twins) can occur in approximately 8 to 10% of patients.

Injectable Gonadotropins (FSH) are prescribed to directly stimulate the ovaries to increase the number of developing follicles. Though the body naturally produces FSH, the FSH offered to patients is in much higher concentrations than the brain normally provides.

Patients taking Injectable Gonadotropins are responsible for administering the drug by injection, usually in the lower abdomen or thigh, beginning on the second or third day of their menstrual cycle. Daily injections are continued until the developing eggs are mature and ready to ovulate.

FSH preparations available at First Step Fertility include:

Repronex - Menopur

  • The risk of birth defects is not higher in women taking FSH.
  • FSH injections do not increase a woman’s chance of developing ovarian or other types of cancer.
  • When FSH injections are combined with IUI, women taking FSH (with otherwise unexplained infertility) may have pregnancy rates of up to 18% per cycle. Please note: This rate may be less in women who are 38+.
  • Women taking FSH because they are unable to produce eggs on their own (polycystic ovary syndrome), may have higher rates of pregnancy – approximately 20-30% per cycle.

Risk Factors

As with any treatment program that involves medication, there are known risk factors associated with taking FSH, which commonly include:

Multiple Pregnancy

Multiple pregnancy occurs in 20 to 30% of instances of patients taking FSH, and in most cases are twins. Triplets and quadruplets occur in less than 1% of pregnancies associated with FSH. In cases where too many eggs develop at once and the risk of multiple pregnancy is too high, your specialist may instruct you to stop taking FSH and avoid sexual intercourse.

Ovarian Hyperstimulation Syndrome (OHSS)

Women taking a course of FSH drugs risk the development of ovarian hyper-stimulation syndrome (OHSS), a condition in which too many eggs develop at once and the hormone levels in the blood become elevated. In some cases, usually when the HCG injection is given, OHSS can happen after the eggs have ovulated.

If your specialist believes you are at risk of developing OHSS, you will be advised to adjust or reduce your dosage, which will slow the development of the condition, or prevent it from worsening. In most cases, the symptoms of this condition may resolve on their own over time, however, if OHSS is severe, you may require other procedures, such as blood work, and draining excess fluids that accumulate internally.

Pain and Inflammation

It is common for women who administer FSH drugs to experience pain or swelling at the injection site, while few patients experience bruising or welts. Discomfort can be relieved by applying ice to the affected area.

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