A very common therapeutic modality in the treatment of infertile couples is the use of medications to stimulate or enhance ovulation. When the patient has irregular menstrual cycles it is very appropriate to initiate “fertility drugs” as one of the first interventions.
In addition, many protocols are utilized that include ovulation medications in an effort to improve the quality of ovulation and the hormonal environment, even in the presence of apparently normal menstrual cycles.
Two main therapies are employed to induce ovulation. The first is the oral agent, clomiphine citrate (Clomid), which is by far the most commonly prescribed, mainly due to ease of administration. It is given for five days, beginning on cycle day 3, 4, or 5, and ovulation occurs approximately on day 15 (but obviously varies from patient to patient). If a lower dose does not achieve an ovulatory result, the dose is increased accordingly. Approximately 80% of women will ovulate at some dose of clomiphine, and about half of the couples will conceive.
If the oral treatment is not successful, we will move on to fertility injections. These drugs are preparations of FSH (follicle stimulating hormone) and/or LH (luteinizing hormone). FSH and LH are the natural hormones from the pituitary gland whose function is to stimulate the ovaries. If ovulation is not accomplished with clomiphine, we can almost always achieve ovulation with injections.
There are also protocols in which the development of multiple eggs is desirable. This is obviously a key component of in vitro fertilization (IVF), but there are also non-IVF cycles where controlled ovarian hyperstimulation is the goal. Utilizing the injections, we would like to mature 2-4 egg follicles to result in one implantation. Multiple pregnancy occurs in 20% of the pregnancies with injections. In contrast, the multiple rate is 10% when clomiphine is administered.
An injection cycle is a fairly involved process, but most patients become very comfortable with the procedures. The shots are given subcutaneously (under the skin, similar to an insulin shot) either in the lower abdomen or front of the thigh using a small needle injected into the fatty tissue. We instruct the couple for the proper administration of these medications. We are always available to give the shots if need be, but surprisingly enough, this is rarely necessary.
When a patient is on the shots, we perform 2-3 ultrasounds in order to monitor follicular development, both for safety to make sure too many eggs are not developing, and to precisely determine the time of ovulation. Although this is a complex and involved cycle, we are there to help you at every step along the way, and more importantly, the pregnancy rate is very satisfying.