Some women ovulate infrequently or do not ovulate at all. Irregular ovulation or anovulation (not ovulating at all) results in irregular periods. These can have a number of reasons but the major ones are stress, weight fluctuations and PCOS (Polycystic Ovarian Syndrome). Thyroid and pituitary gland disorders raised prolactin level, and ovarian failure are some of the other reasons for not having regular ovulation. Ovarian failure may happen as a result of cancer treatment or menopause.
Therefore, when a woman is not ovulating by herself and if she is in a childbearing age and she is not developing mature follicles every month or does so but not as regular as other women, it might be impossible or very tough for her to get pregnant. Aside from that, irregular periods have a big impact on a woman’s mood, sleep, hair, skin and generally on her daily life quality. This is where “ovulation induction” is recommended to the person suffering from this condition.
To determine the follicles development, a pelvic ultrasound is performed to reach the endometrium (lining of the womb). Blood tests may also be done to measure hormone levels to identify a woman’s most fertile time of the month (a time when a woman is most likely to ovulate every month).
In order to successfully treat ovulation problems, the root cause must be identified. To this end, several blood tests and an ultrasound of the womb must be done. With the blood tests, the levels of thyroid hormones, prolactin, FSH, testosterone and other androgens (male hormones) must be measured. The ovary must be also evaluated in order to see whether it is capable of responding to the treatment or not. High concentration of FSH (FSH>10) and low AMH concentration at the beginning of the period, is indicative of a probable ovarian failure. In such cases, the treatment will not be useful, so if anovulation and oligoovulation are secondary to another disease, the “ovulation induction” treatment will not work unless the root cause is taken care of.
OVULATION INDUCTION CANDIDATES
The following are candidates for ovulation induction:
Women who ovulate infrequently
Women who do not ovulate at all (anovulation)
Women with unknown infertility problems who do ovulate regularly;
These women can benefit from ovulation induction to increase the number of times they ovulate during one cycle to give them better chances to conceive and get pregnant.
Women who are undergoing IVF treatment to increase their egg production
OVULATION INDUCTION METHODS
There are several methods for ovulation induction, depending on how responsive are the ovaries to each method.
The methods are as follows:
Ovulation induction using one of the medication regimens, which we will discuss below
Metformin (especially prescribed for women with PCOS)
Ovulation induction using medication
Ovulation induction is induced with one of the following drug regimens:
Clomiphene citrate or Clomid tablets
How does Clomiphene citrate work?
Clomid, also known as Serophene or its alternatives (Tamoxifen and Letrozole tablets) increases the follicle stimulating hormone (FSH) and Luteinizing (LH) production by the pituitary gland. Clomiphene works by tricking the body into thinking that it is deficient or low in estrogen. The pituitary gland sends signals to the ovary, after getting impulses from higher centers in the brain, to stimulate the development of the follicles and eggs growth. An LH surge will happen a few days after stopping taking clomiphene citrate, and 36 hours after this surge the patient will start to ovulate.
This tablet is usually given at a starting dose of 50 mg for 5 days of a cycle, usually starting from the second day of the period. Although FDA has approved of a daily intake of 125 mg, the dose will only be increased if the patient does not respond to 50 mg dose and they fail to ovulate; as a result, it will be increased to 100 mg per day. If periods are very irregular and infrequent, in order to induce periods, another tablet regimen might be needed. This tablet is called Norethisterone.
How effective is Clomiphene citrate?
The effectiveness of Clomid is dependent on a number of reasons, such the age, infertility issues and seminal parameters.
If a pregnancy is achieved with clomiphene citrate, the chances for twins is about 6- 10% and for triplets or higher is 1% or less.
Clomiphene side effects
Clomiphene citrate usually has no immediate serious side effects, but blurred vision, hot flushes, and mood swings may happen.
Gonadotropins or Gonadotrophins
How does Gonadotropins work?
This is an injective method of ovulation induction. An injection is done with a small needle daily. These daily self-injections must be continued for 5-12 days. The starting dose varies from patient to patient in order to optimize the probability of conceiving and reduce the chances of multiple pregnancies. The right dosing will be adjusted by monitoring the patient with ultrasound and hormonal evaluation. This injection works by maturing the eggs inside the follicle. Afterward, with an HCG injection which mimics mid-cycle physiologic LH surge, ovulation will happen.