Ovulation Induction

Ovulation induction is a procedure in which medication is used to stimulate a woman's ovaries to ovulate and produce eggs. Ovulation induction commonly uses fertility drugs to stimulate the follicles in the ovaries in order to produce multiple eggs during each menstrual cycle. This process is often performed as a fertility treatment. With additional control over the timing of egg release, there is a significant increase in the likelihood of fertilization. These medications may be used to assist with fertilization naturally through sexual intercourse, or in conjunction with in vitro fertilization, or IVF. In extreme cases when medication to induce ovulation has been unsuccessful, surgery may also be performed to increase the chances of ovulation.

Reasons for Ovulation Induction

Ovulation induction is the use of drugs to induce a woman's ovaries to release an egg. This treatment is often used when ovulation is irregular or does not occur at all. Used as a means of increasing fertility, ovulation induction may be performed on women with the following conditions that may affect ovulation:

  • Irregular menstrual cycles or absence of menstruation
  • Polycystic ovary syndrome
  • Abnormal hormone levels
  • Thyroid disease
  • Obesity

Ovulation induction may also be performed on women who experience ovulation difficulties due to eating disorders or extreme weight loss.

Types of Ovulation Induction

Depending on the cause of infertility, there are different levels of ovulation induction available, which can range from oral medication taken for a few days, to daily injections or surgical procedures. The intent of most medications is to temporarily correct ovulation problems and increase a woman's chance for pregnancy. Fertility drugs may also be used to correct other fertility problems such as improving the lining of the uterus, in addition to inducing ovulation. In certain circumstances, these medications also may be used to stimulate the development of multiple eggs. Common medication used for ovulation induction treatments may include the following:

  • Clomiphene citrate
  • Metformin
  • Letrozole
  • Gonadotrophins

In cases where fertility medication has not been effective at inducing ovulation, ovarian drilling may be performed. Ovarian drilling is a laparoscopic surgical procedure that creates several surface lesions on the ovary, which may help to trigger ovulation.

The Ovulation Induction Process

The ovulation induction process varies according to the method of treatment and diagnosis by the physician. Oral medications, such as clomiphene citrate, may be taken for five days after the start of the period, for up to six months. If the patient has not achieved pregnancy after six months, the doctor will reevaluate and likely modify the treatment. Injectable medications, such as gonadotrophins, may be given in varying doses on different days of the woman's menstrual cycle. Injections are given daily and the dosage may be increased every five to six days until pregnancy is achieved, for up to six months. Some treatments are available in self-injectable pens. Intrauterine inseminations, or IUI, may be performed 24 to 36 hours after the injection to coincide with ovulation. After ovulation the physician may prescribe progesterone to improve the chances of successful implantation.

Risks of Ovulation Induction

Side effects of fertility medications for ovulation induction are mild and may include hot flashes, nausea, bloating, headache, and blurred vision. Injectable medications may also include soreness, bruising, and swelling at the injection site. While ovulation induction can effectively achieve fertilization for some patients, there are certain risks associated with these medications that must be taken into consideration. Women who conceive using fertility drugs have a higher chance of:

  • Multiple births
  • Ovarian cysts
  • Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome, or OHSS, is a rare but serious complication of fertility medication treatment. OHSS occurs when hormone injections used for ovulation induction cause hormone levels to rise sharply and over stimulate egg production in the follicles in the ovaries. Symptoms range from mild to severe and may include nausea, vomiting, excessive fluid retention, thrombosis, abdominal swelling, enlarged ovaries and sometimes kidney failure. OHSS can be a life-threatening condition and may require hospitalization.

Ovulation induction treatments may be costly and may not be covered by insurance. This can be a factor in the patient's selection of fertility treatments. A doctor will determine whether or not ovulation induction is an option, based on a thorough evaluation of the patient's overall health and fertility issues.

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