Ovulation Induction

Clomiphene citrate and Letrozole are oral medications used in ovulation induction for intrauterine insemination (IUI). These medications are used in patients who do not ovulate regularly or to stimulate more than one egg to mature each month. Patients will be monitored starting at the beginning of their cycle and will start oral medications once they are cleared by their physician. We will monitor the developing follicles and schedule IUI when the eggs are ready.

For more information, please refer to the information provided with the medications.

Injectable gonadotropins are another group of fertility drugs often prescribed for ovulation induction. These medications directly stimulate the ovaries to increase the number of developing follicles. The medications are produced with varying combinations of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), or as single purified agents. These medications are also referred to as gonadotropins.

As part of natural processes, FSH travels from the brain to the ovaries to promote egg development. The FSH given to patients via injection provides much higher concentrations than the brain would naturally create.

Patients inject these medications on their own, and the clinic supports them with training and resource videos. Daily injections continue until the developing eggs are mature and ready to ovulate, which we track through cycle monitoring visits.

The FSH preparations available at our clinic include: Puregon, Gonal-F, Repronex and Menopur.

When FSH injections are combined with IUI, women with unexplained infertility may increase their pregnancy rate per cycle by up to 18%. (Please note: this rate may be less in women who are 38 years or older.)

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.

The risks of this method include pain, inflammation and swelling at the injection site. Many patients find relief by applying ice to the area. Relatively few patients also experience bruising or welts around the injection site.

One of the major risks of using FSH medication is multiple pregnancy (becoming pregnant with more than one child). Based on the number of developing eggs seen on ultrasound, the doctor will advise the patient of her risk of multiple pregnancies. In cases where too many eggs develop at once and the risk of multiple pregnancy is too high, the patient may be instructed to stop taking FSH and to avoid having intercourse.

Patients taking gonadotropins may also develop ovarian hyperstimulation syndrome (OHSS). This condition occurs when too many eggs develop at once and the hormone levels in the blood become too high. In some cases, OHSS can happen after the eggs have ovulated. If the doctor believes a patient is at risk of developing OHSS, she will be advised to adjust or reduce the dose of gonadotropins being taken. This will slow the development of the condition and/or prevent it from worsening. For most women who develop this condition, the symptoms resolve on their own over time. If the hyperstimulation is severe, the patient may require other procedures, such as close monitoring, blood work and drainage of the excess fluid that may accumulate internally.

The risk of birth defects is not higher for women taking FSH.

FSH injections do not increase a woman’s chances of developing ovarian cancer or any other type of cancer.

Our nursing team will demonstrate how to properly administer medications from home. We also have learning videos available online.