Ovulation Induction

A significant proportion of women have some degree of ovulatory disorder; that is, they do not mature and release eggs in a timely fashion. These ovulatory disorders can range from mild, resulting in variable menstrual cycles, to severe, resulting in months-long episodes of menstrual absence or uncontrolled bleeding. Some of these problems, in the lay literature, are referred to as PCOS or PCOD. Nevertheless, all of these ovulatory problems can result in some degree of an impediment to getting pregnant. Ovulation induction is the general term applied to the correction of these ovulatory problems. First-line treatments can involve the use of oral ovulatory agents, such as clomiphene citrate or letrozole. The therapeutic goal of this treatment is to restore the patient to normal reproductive physiology, with one egg on time every month. Occasionally, especially in younger patients, these medications may result in the maturation of more than one egg. If the patient’s ovulatory disorder is resistant to even maximal doses of these oral medications, it may be necessary to move on the injectable fertility medications. These medications are given as daily shots, usually for 10 to 14 days. During the time these injections are being given, pelvic ultrasounds and blood estrogen levels are performed approximately every three days to determine the ovarian response. These ultrasounds and estrogen levels together are frequently referred to as “monitoring.” It is not uncommon to have more than one egg mature simultaneously when using injectable fertility medications. The clinical goal is no more than two mature eggs. When the egg/eggs are mature, a final injection is given to induce their release. The couple then has timed intercourse, or artificial insemination is performed. There are two prerequisites for patients to be considered good candidates for ovulation induction. First, the sperm has to be relatively normal or at least within the working limits of artificial insemination. The second prerequisite is that the woman’s reproductive organs (uterus, tubes, and ovaries) need to be anatomically normal.