Induced Ovulation: A Patient's Guide

Many newly married couples in the U.S. and around the world are forced to confront medical conditions that while not physically dangerous, can play havoc with their emotions and plans for the future. Infertility can be discovered after a woman or couple begins trying to start a family, however usually, there are indicators from the teenage years, such as irregular menstrual cycle and the professional diagnosis of polycystic ovary syndrome or oligomenorrhea. There are many variations and degrees of infertility. The lesser types are not signified by total and complete loss of the ability to get pregnant, but only by a decreased ability of egg production and regular ovulation cycles.

There are several methods of artificially inducing ovulation and producing healthy eggs in women. Most of these are through fertility drugs and hormones. Which one is right for your specific condition must be determined by your doctor or fertility specialist after undergoing a series of physical examinations, blood work, and analysis. To better explain how the drugs for induced ovulation work, we must first look at a normal menstrual and egg production cycle.

The average human menstrual cycle is 28 days and begins with the stimulation of the follicles in the two ovaries connected to the outside of the uterus. In the first 10-14 days, beginning on the first day of menstruation, the hypothalamus in the brain releases a hormone known as GnRH. This hormone signals the pituitary gland to release a second hormone called FSH, or follicle-stimulating hormone. It is the FSH that signals the follicles to develop new eggs. In a normal cycle, one follicle will achieve dominance to produce the egg, with the other follicles relaxing and allowing the dominate follicle to do its work. At the end of the 10-14 day stimulation time, the egg will reach maturity and a surge of luteinizing hormone (LH) will signal for release of the egg into the fallopian tube.

The luteal phase of the menstruation cycle lasts 12-16 days, beginning with the LH surge. Once the egg is released from the ovary and travels down the fallopian tube, it will either be fertilized by the presence of sperm and implanted into the uterus for gestation of the embryo, or if not fertilized, will pass through the uterus and be discarded from the body during menstruation.

No matter what the cause may be of a woman's irregular ovulation, there are means of stimulating incomplete or retarded egg production, although this should not be a first choice. The American Society for Reproductive Medicine, in its publication, "Medications For Inducing Ovulation: A Guide for Patients," explains that treatment of the underlying causes of the irregular ovulation must first be accomplished. If treatments are not available, or they are unsuccessful, then induced ovulation can be looked into.

The four most common medications for inducing ovulation are clomiphene citrate, FSH, human chorionic gonadotropin (hCG), and human menopausal gonadotropin (hMG).

Clomiphene Citrate is the most common drug used to stimulate ovulation and is sold under the Brand names of Clomid and Serophene. This drug stimulates a greater production of FSH to stimulate the ovaries into producing eggs. It is administered in the beginning days of the menstrual cycle in 50 mg doses for 5 days by oral consumption of tablets. It is effective at a rate of 45% within 6 months. Side effects are mild and easily tolerated. They may include: multiple births, thick cervical mucus, hot flashes, nausea, headaches, blurred vision, depression, and/or pelvic discomfort.

FSH may also be administered directly through injection to induce ovulation. If prescribed, it can be self-administered through an injection pen such as those used for insulin or severe allergies. Common side-effects of injecting FSH are: multiple births, increased chances of miscarriage or premature delivery, breast swelling, and depression.

Human Chorionic Gonadotropin, or hCG is similar to the natural LH of human women. hCG is usually used to trigger the follicles to release eggs and is often used in concert with another ovulation inducing drug such as Clomiphene Citrate. hCG is administered through injection and there are no known side-effects.

Human Menopausal Gonadotropin, or hMG contains natural FSH and LH obtained from post-menopausal women who continue to produce high levels of these hormones. Women who are anovulatory (not producing eggs) and have no other conditions can expect normal pregnancy rates for their age. It is administered through injection by a health professional beginning on the 2^nd or 3^rd day of ovulation. The treatment is daily and continues for a period of 7 to 12 days. Once a follicle reaches maturity through the administration of hMG, release of the egg is commonly triggered through hCG. The side-effects of hMG are similar to those of FSH.

Although these are the most common methods of inducing ovulation, there are a number of other treatments. For more information on these, please refer to the American Society of Reproductive Medicine website at www.asrm.org.

Sources:

American Society of Reproductive Medicine, "Medications For Inducing Ovulation," http://www.asrm.org/Patients/patientbooklets/ovulation_drugs.pdf

Wikipedia, "Ovulation," http://en.wikipedia.org/wiki/Ovulation