Ovulation Induction

Ovulation induction involves administering medication to induce follicle development and ovulation.   Ovulation induction can be coupled with carefully timed intercourse and/or intrauterine insemination (IUI).  

You may be administered a Clomid Challenge Test to measure your ovarian reserve.

Clomiphene Challenge Test
A doctor may order basal hormonal testing as well as provocative hormonal testing (clomiphene challenge test). This will aid the doctor in predicting the responsiveness of your ovaries and evaluation of your ovarian reserve. The testing will involve measuring your blood follicle stimulating hormone (FSH) level on cycle day 2 or 3 of your menstrual cycle and then on day 10 following a five-day course of Clomid or Serophene. Remember the first day of flow that requires you to wear a pad or tampon is cycle day 1. Follicle stimulating hormone (FSH) is produced by the pituitary gland (an area in the brain) and causes follicles to develop. A follicle is a cystic structure on the ovary, which houses the egg prior to ovulation. Measuring these hormone values on cycle day 2 or 3 and again following a course of Clomid or Serophene on cycle day 10, may identify the patient who is not likely to conceive or is at a high risk for miscarriage. The testing involves having your blood drawn on cycle day 2 or 3 for FSH and estradiol levels. Pending the results of the day 2 or 3 blood test, you will be instructed to take clomiphene two tablets (100 mg) daily on cycle days 5 through 9. You will return for a second FSH level on cycle day 10.

A common medication used for ovulation induction is Clomid or Serophene (clomiphene citrate).  Clomid binds to estrogen receptors in the body and "fools" the hypothalamus (an area of the brain) into thinking estrogen is low and causes it to make and release more gonadotropin releasing hormone (GnRH).  GnRH causes the pituitary to make and release more follicle stimulating hormone (FSH) and luteinizing hormone (LH). More FSH and LH should result in the release of one or more mature eggs - ovulation.  One disadvantage of Clomid is that it can bind to estrogen receptors for 6-8 weeks in many types of tissues and deprive these tissues of estrogen, leading to diminished endometrial development (uterine lining) and decreased cervical mucus production

Recently, doctors have been prescribing another drug called Femara (letrozole), commonly used to treat breast cancer, to induce ovulation.  This drug is not yet approved by the FDA for this use.  Femara is used in a similar fashion to Clomid and also has similar effects.  Femara is an aromatase inhibitor.  Aromatase is an enzyme that converts androgens into estrogen.  Femara stops the action of this enzyme, thus lowering the amount of estrogen in the body.  This in turn causes the body to take the steps necessary to produce more estrogen (GnRH, FSH, & LH as described above), thus causing follicle development and ovulation.  Femara has a very short half-life and does not remain in the body to cause problems with cervical mucus or the uterine lining.

The following is a sample protocol for ovulation induction:

Ovulation induction medication is typically given on days 3 through 7 or days 5 through 9 of your cycle (day 1 being the first day of regular menstrual flow).  The medication is typically given in tablet form and taken orally, but can also be administered as an injection.  Before beginning the medication, your doctor may want to do a sonogram to ensure you do not have any cysts on your ovaries, as the medication would cause any cysts to grow and possibly rupture.  The medication can typically be taken any time of day, but it is suggested you take it around the same time each day.  The beginning dosage is 50 mg/day for Clomid or 2.5 mg/day for Femara.  If you do not respond to this dosage, it may be increased on the next cycle.  When the date of ovulation approaches, your doctor may do a sonogram to look for a mature follicle.  At this time, your doctor may choose to trigger ovulation by administering an HCG shot.  If your ovulation induction will be coupled with IUI, the IUI will be performed within 36-48 hours of the HCG shot.  After ovulation, your doctor may choose to supplement you with progesterone.  A pregnancy test may be administered 11-12 days after ovulation.  If you had an HCG trigger shot, you will need a quantitative HCG pregnancy test to measure the level of HCG in your blood.  HCG is also known as the pregnancy hormone, and is the hormone that home (urine) pregnancy tests measure for.  Residual HCG will remain in your body after the trigger shot and can cause a false positive on a home pregnancy test.

Good luck!

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Last modified: March 22, 2006