Ovulation is the release of a mature egg from the ovary. In
order for ovulation to occur, the body must produce different hormones in the
right order, in the right amount, and at the right time. It is a finely tuned
process. It is no wonder, then, that different types of hormone imbalances
occur and cause problems with ovulation. These ovulation problems can be
treated with medication and this helps the woman ovulate normally, which in
turn increases her chances for pregnancy.
The drugs that correct the hormone imbalance are called
ovulation induction medications. The medications are used in women who do not
ovulate regularly; do not produce a fully developed egg; do not make enough
progesterone (the hormone that maintains and supports a pregnancy); or to time
artificial inseminations correctly. The most frequently used fertility drug is
a pill called Clomiphene citrate (also called Clomid
or Serophene). If a woman's ovulation problems are not or can not be corrected
with the "fertility pill" then different fertility drugs can be used.
These drugs are given by injections (shots) and are called Pergonal, Metrodin, or Humegon.
Clomiphene citrate, Serophene, or Clomid are different names for
the same drug, the "fertility pill". Clomiphene citrate works by
occupying estrogen receptor sites in the brain and this prevents estrogen from
binding to these sites. This action fools the body into thinking that the
estrogen levels are lower than they really are. In response to this, the brain
releases even greater amounts of hormones. These hormones (FSH = follicle
stimulating hormone and LH = luteinizing hormone) act directly on the ovaries
to produce more follicles (eggs) and thus more estrogen. These events result in
the ovaries making a larger number of follicles and in improving the quality of
The dose of Clomiphene citrate
and the days you take the medication vary according to your individual
menstrual cycle and your response to the medication. Staff will monitor your
response to the medicine with ultrasound examinations and blood tests of your
hormones. These tests give us a good idea of what your ovaries are doing and
when the eggs will be ready to ovulate. When the follicles are mature and are
ready to release the egg, an injection (shot) of hCG (human chorionic
gonadotropin or Profasi) will be given to you. You can then expect ovulation to
occur within the next 36 hours. Talk with the staff about the timing of
intercourse, or for the scheduling of artificial insemination.
Clomiphene citrate may
cause side effects which can be annoying but are rarely serious. The side
effects include hot flashes, lower abdominal aching or bloating, nausea,
headaches, fatigue, crankiness/moodiness and changes in your menstrual flow.
Please contact your physician if you experience severe lower abdominal pain,
severe headaches, or significant visual changes.
Clomiphene citrate can
induce ovulation in 60-70% of women who had not been ovulating. About 50% of
the couples will achieve pregnancy within 6 months of treatment. There is an 8%
chance of having twins and the likelihood of having more than two babies is
less than 1%. There is no increase in the risk of birth defects in children
conceived with Clomiphene citrate.
If you do conceive on
Clomiphene, your pregancy will will be monitored closely with ultrasounds and
hormone blood studies. If, however, you do not conceive, an ultrasound needs to
be done before restarting the fertility medication. This is done to make sure
there are no cysts remaining on your ovaries before taking your medication.
Human gonadotropin (Pergonal, Metrodin, or Humegon) are
the most powerful ovulation induction medications available. The medications
are made of hormones (FSH/LH or FSH) that are normally released by your brain.
These medications do not work if taken in pill-form, and have to be given by
injections (shots). To make it more convenient for you, the staff will teach
you, your husband, or a friend how to give these shots.
Before you begin the
medication, an ultrasound will be needed to ensure your ovaries are "quiet
and at rest". The medication is started early in your menstrual cycle, and
is given daily. The amount of medication and the length of time you will
receive the injections will depend on your individual response. Your response
will be monitored by several ultrasound examinations and blood studies of your
hormone levels. When your hormone levels reach the appropriate level and the
follicles (eggs) are mature, then additional medication (Profasi, hCG-human
Chorionic Gonadotropin) is given to trigger the release of the eggs from your
ovaries. You can expect ovulation to occur within the next 36 hours. Talk with
the staff about the timing of intercourse or for the scheduling of artificial
The side effects of
these medication may include abdominal bloating, lower abdominal aching or
discomfort, breast tenderness, mood swings, and fatigue.
The risks of this
medicine are multiple gestation (twins, triplets, quadruplets, etc.), and
ovarian hyperstimulation syndrome. Multiple gestations are increased with the
use of this potent fertility medication. The risk of twins is 20%, triplets 2%,
and 2% for more than three babies. Pregnancies complicated by multiple
gestations are at increased risk for premature deliveries, pre-eclampsia (high
blood pressure) and gestational diabetes. Ovarian hyperstimulation syndrome is
a complication that occurs when the ovaries "over-respond" or
overstimulate. Many, many eggs are produced causing the ovaries to swell,
enlarge, and become very painful. This can cause a chemical imbalance in your
body and a fluid collection in your abdomen and lungs. Women who experience
this complication (less than 3%) may be hospitalized, given pain medication and
are monitored closely for several days. If after ovulation treatment with
injections, you experience severe abdominal pain, nausea, vomiting, dizziness,
weakness, or shortness of breath, call your physician.
The miscarriage rate
after the use of the "infertility shots" is 20-30% and this is higher
than the miscarriage rate of 15% after spontaneous conception. There is no
increase is the incidence of birth defects.
Once you have conceived,
your pregnancy will be closely monitored with ultrasounds and hormone blood
Date last updated: January 6, 2003