Treatment Options

Ovulation Induction

How does Ovulation Induction work?

Ovulation Induction is the use of fertility medication to induce ovulation in a woman trying to conceive. The fertility drugs are used to stimulate the follicles in your ovaries, which would result in the production of one or more eggs in your cycle. The meticulously timed ovulation allows you to schedule sexual intercourse, Intrauterine Insemination, and/or In-Vitro Fertilization procedures to boost your chances of achieving pregnancy.

Understanding Ovulation Induction

While there are some considerations to keep in mind when using ovulation induction medications, it’s important to remember that they are generally safe and well-monitored. These medications may increase the likelihood of having multiple births or the development of ovarian cysts. In rare cases, Ovarian Hyperstimulation Syndrome (OHSS) can occur, which may lead to symptoms such as pelvic and abdominal discomfort, nausea, vomiting, bloating, weight gain, and breathing difficulties.

The most commonly used fertility medications, including clomiphene citrate, Letrazole, gonadotropins, and hCG, are carefully administered to achieve the desired results. These medications, sometimes referred to as “super-ovulating drugs,” aim to stimulate the ovaries to produce multiple eggs. They are typically delivered through injections, such as Follistim, Gonal-F (FSH), and/or Menopur (HMG), once or twice a day, with close monitoring by medical professionals to ensure your safety and comfort throughout the process.

Commonly-used Medications

Tablets

Clomiphene Citrate
Letrazole
Gonadotropins
Human Chorionic Gonadotropin (hCG)

Injections

Follistim
Gonal-F (FSH)
Menopur

Ultrasound

After receiving tablets and/or injections for approximately five days, a transvaginal ultrasound will be performed at RFC. Our specialist will use ultrasound waves to project a white image on the monitor to monitor the number of follicles and their development. Follicles are round sacs of fluid within the ovaries. Therefore, the follicles appear as dark circles on the ultrasound screen. Most follicles should contain an egg; however, the eggs cannot be seen during the ultrasound. In some cases, the follicle has no eggs and in others the follicle contains more than one egg. The number of follicles, therefore, does not correspond to the number of eggs.

Treatment

Treatment begins on approximately Day 2, 3, or 4 of your menstrual cycle. You may undergo frequent blood samplings to determine your estradiol level. This level is used to individualize your medication treatment for that afternoon and the following morning. Estradiol is produced by the lining of the follicle. Additional laboratory testing, such as LH, FSH, and/or progesterone levels, are used to monitor follicular development. After physician review of your estradiol numbers, you will be notified of any change in your medication dosages.

Retrieval

When your fertility doctor determines that you are ready for retrieval, you will be given instructions on how to administer an injection of hCG, Ovidrel, or Novarel. This injection is given late in the evening approximately 35 hours prior to retrieval. This medication ripens the developing eggs and initiates ovulation. Ovulation occurs about 42 to 48 hours from the time of injection if you do not have an egg-retrieval procedure. Many patients experience abdominal discomfort after the hCG due to ovarian enlargement and are convinced that they are ovulating. Rest assured that we are monitoring you very closely, and the chance of ovulating prior to retrieval is extremely slim, and almost zero if you are receiving Lupron, Antagon or Cetrotide.

Sexual abstinence too long before retrieval (more than five days) or relations too close to retrieval (24 hours) could possibly decrease the quality of the semen sample. If you did not have sexual relations the day before hCG, we recommend that you do the day of hCG. If your husband has a low sperm count you may need a 4-5 day period of abstinence. Your fertility specialist will discuss this with you early in your cycle, should you have any questions regarding this matter.