For people who are not ovulating regularly, the goal of treatment is to mature and ovulate a single egg — this is known as ovulation induction.
About 50 percent of treatment cycles performed at Shady Grove Fertility include ovulation induction and intrauterine insemination (IUI) — basic treatments requiring less medication and fewer monitoring appointments with a lower cost.
Ovulation induction process
Clomiphene citrate (Clomid, Serophene) is a commonly used ovulation induction medication. It is used primarily to treat women who have ovulation disorders as reflected by infrequent or irregular menstrual cycles. Approximately 80 percent of women taking clomiphene citrate will successfully ovulate, but fewer than 50 percent of patients will conceive.
Though clomiphene citrate is generally well tolerated, it can cause hot flashes and mood changes as well as lead to cervical mucus changes and thinning of the uterine lining that can negatively impact success rates. Another risk to consider is the increased chance of multiples — which is around 10 percent — compared to the natural rate of twinning, which is between 1 to 2 percent.
Step 1A: Ovarian stimulation | Medications
The main goal of this phase is to induce ovulation with common medications like Clomiphene citrate (Clomid, Serophene). Clomid facilitates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which stimulates the ovaries to produce eggs and the ovarian hormones estradiol (E2) and progesterone (P4). Patients can expect to orally take Clomid for 5 to 7 days typically starting on day 3 of a their menstrual cycle. It’s best to take the medications daily at bedtime, or as instructed by the physician. Additionally, the physician may prescribe an Ovidrel injection to trigger the egg release.
Step 1B: Ovarian stimulation | Monitoring
The physician will monitor egg development with E2 and LH hormone tests and ultrasound scans of the ovaries to determine when the eggs are mature. Increased levels of estrogen are a good indicator of follicular development. Additionally, ultrasounds help physicians see the thickness of the uterine lining and ovaries and the number of follicles within them.
Step 2: Timed intercourse, if applicable
If the patient is taking the timed intercourse treatment path, intercourse is instructed on the day of the trigger shot and then again 2 days later to increase potential chances for conception.