Ovulation induction uses medication to help women with irregular cycles and polycystic ovary syndrome (PCOS) and other infertility issues become pregnant. The health care professionals at IVFMD, with locations in Irving, Grapevine and Arlington, Texas, are experts in ovulation induction and work closely with you to determine whether this is the best fertility treatment for your circumstance. For answers to all of your fertility questions, including ovulation induction, call IVFMD today for an appointment or use their convenient online scheduling service.
There are three common indications for using medications to induce ovulation:
FSH (Follicle Stimulating Hormone) is a hormone released by the pituitary gland in the brain. FSH stimulates follicular growth and development. FSH release from the brain can be induced by pills such as Clomiphene (Clomid) and Femara (Letrazole) or it can be given directly by subcutaneous injection. When the ovary is quiet the estrogen levels are low and the ovarian follicles are small.
Both pills, Clomid and Letrazole, trick the brain into believing that the ovaries are not working and thus the pituitary releases more FSH, resulting in mono-follicular, or sometimes, multi-follicular development. These pills are usually taken for 5 days and this is generally enough to induce ovulation.
The subcutaneous injections contain FSH and directly stimulate follicular development. Injections bypass the natural checks and balances of the brain and thus the chance of multi-follicular development is higher. Multi-follicular development usually results in higher pregnancy rates but also, not surprisingly, in a significantly higher chance of twins or multiples, which we consider a risk from these treatments.
To coordinate the timing of insemination, induce the rupture of the follicle and improve the levels of progesterone production (to support the early pregnancy), we generally use a trigger injection once the follicle has reached maturity. Maturity is determined by follicular size on ultrasound or a natural LH surge.
The egg is usually released 28 to 42 hours after the trigger or LH surge, and thus patients are counseled to have an insemination during this timeframe and/or intercourse over the 3 days that follow. Intercourse every day and every-other-day is practically equally effective, with lower pregnancy rates as the interval increases.
Menses generally comes two weeks after the LH surge or trigger, unless pregnancy occurs. Low progesterone levels and a short luteal phase are usually indicative of a progesterone deficiency. We supplement these patients with progesterone and others at high risk, such as those with high prolactin levels, thyroid dysfunction or a history of pregnancy loss.