What is ovulation induction?

What is ovulation induction?

Problems with ovulation are common and account for 25% of female infertility cases. Fertility medications help cause regular ovulation by stimulating the ovaries to produce, mature, and release one or more eggs per cycle. 

Women who could benefit from treatment cycles with ovulation induction (OI) medications may have:

  • No ovulation (called anovulation) 
  • Infrequent ovulation (called oligo-ovulation) 
  • Minimal to mild endometriosis

Ovulation is required in order to conceive, but the menstrual cycle is extremely sensitive and can be disrupted easily. Many factors cause anovulation and oligo-ovulation, including hormonal imbalances, polycystic ovaries (PCOS), and obesity.  

Fertility medications controlling ovulation are prescribed on their own or as an integrated regimen with intrauterine insemination (IUI) or assisted reproductive technology (ART) procedures like in-vitro fertilization (IVF). Although there are a wide variety of medicines available, there are two main types of drugs used in ovulation induction: estrogen-blocking oral medications, and injectable gonadotropins.

Estrogen-blocking oral medication

How it works

Estrogen blockers are tablets taken by mouth. They work by triggering the pituitary gland, located in the brain, to make more follicle stimulating hormone (FSH). The additional FSH causes follicles—fluid-filled sacs containing eggs—to develop.

The follicles release estrogen as they grow, which eventually causes your pituitary gland to release a large amount of luteinizing hormone (LH). This LH surge causes the eggs in the most mature follicles to be released, which is called ovulation.

Who it’s for

Estrogen-blocking oral medications are commonly recommended for women who:

  • Haven’t had fertility treatments before
  • Have been diagnosed with PCOS
  • Are unable or unwilling to pursue more aggressive therapies

They may also be used in conjunction with IUI in women with unexplained infertility.

Possible side effects*

  • Hot flashes, mood swings, breast tenderness, or nausea 
  • Rarely, headaches or vision problems  
  • Ovarian cysts, which typically disappear over time
  • Increased chance of getting pregnant with multiples (twins, triplets, or more), which can have health risks for both the mother and babies

*This may not represent all side effects. Please discuss with your healthcare provider.

Estrogen blockers by the numbers
Note: Treatment cycles can be affected by many variables. The numbers above represent ranges and may not reflect your experience. Please discuss your personal treatment protocol with your healthcare provider.

What women can expect in a cycle

STEP 1: Testing & assessments

A thorough assessment of your reproductive health is necessary before you begin your cycle. Your RE will conduct examinations, ultrasounds, and blood work to assess your current fertility.

STEP 2: Estrogen-blocking oral medication

You’ll usually begin treatment a few days after your period begins.

STEP 3: Monitoring

Blood work may be conducted leading up to ovulation to monitor follicle growth and hormone levels.

STEP 4: Ovulation

Estrogen-blocking oral medications do not trigger ovulation in all women. Depending on your response to the drug, your doctor may adjust your dosage or talk to you about other fertility medications, such as gonadotropins.

STEP 5: Two-week wait

After ovulation comes a waiting period before a pregnancy test can be taken known as the “two-week wait.” This can be a difficult time, filled with hope and anxiety. Building a support network can help you during the wait.

STEP 6: Pregnancy testing and care

If you get the joyous news of a positive pregnancy test, your clinic will closely monitor your pregnancy with scans and blood work to ensure the health of you and your baby. You’ll be released to your OB when your pregnancy is 8 to 10 weeks along.

Gonadotropins

How they work

Gonadotropins are injectable medications that directly stimulate the ovaries to promote egg maturation and release. They contain one or both of the reproductive hormones produced naturally in a woman’s body: FSH and LH.

Who it’s for

Gonadotropins are commonly recommended for women who:

  • Have not had success with estrogen-blocking oral medications
  • Are pursuing IVF or a similar treatment and need to produce more follicles

Possible side effects*

  • Abdominal pain and headache
  • Ovarian hyperstimulation syndrome (OHSS), a condition in which lots of follicles develop and can lead to hospitalization
  • Increased chance of getting pregnant with multiples (twins, triplets, or more), which can have health risks for both the mother and babies

*This may not represent all side effects. Please discuss with your healthcare provider.

Gonadotropins by the numbers
Note: Treatment cycles can be affected by many variables. The numbers above represent ranges and may not reflect your experience. Please discuss your personal treatment protocol with your healthcare provider.

What women can expect in a cycle

STEP 1: Testing & assessments

A thorough assessment of your reproductive health is necessary before you begin your cycle. Your RE will conduct examinations, ultrasounds, and blood work to assess your current fertility.

STEP 2: Gonadotropins

Your doctor will prescribe gonadotropins with either follicle stimulating hormone (FSH) alone, or FSH together with luteinizing hormone (LH). You’ll give yourself injections at least once a day, for a week or more.

STEP 3: Monitoring

Follicle growth and hormone levels will be monitored with ultrasounds and blood work.

STEP 4: Ovulation

When your eggs are almost mature, most women will receive an injection of human chorionic gonadotropin (hCG), which mimics the natural luteinizing hormone (LH) surge your body experiences before ovulation. This triggers the ovaries to release an egg. This is often called a “trigger shot.”

STEP 5: Two-week wait

After ovulation comes a waiting period before a pregnancy test can be taken known as the “two-week wait.” This can be a difficult time, filled with hope and anxiety. Building a support network can help you during the wait.

Note that pregnancy tests measure the level of hCG in the urine or blood. Therefore, it’s important to take a pregnancy test only when advised by your doctor, because the test may pick up the hCG from the trigger injection and show a false positive result.

STEP 6: Pregnancy testing and care

If you get the joyous news of a positive pregnancy test, your clinic will closely monitor your pregnancy with scans and blood work to ensure the health of you and your baby. You’ll be released to your OB when your pregnancy is 8 to 10 weeks along.

Ovulation induction and IVF

Often, ovulation induction is used in conjunction with ART procedures like IVF to stimulate more than one follicle per cycle.

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