Ovulation is dependent on a delicate and consistent balance of reproductive hormones. If the body does not produce these hormones in exactly the right way, a hormonal imbalance or deficiency — referred to as ovulatory dysfunction — can cause infertility in women. Treatment with gonadotropins or “fertility drugs” can increase the likelihood of getting pregnant. Fertility drugs work by stimulating inactive ovaries to ovulate or produce more than one egg at a time.
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Several different medications can artificially trigger (and sustain) the development of follicles with egg cells. The first line of treatment is often oral medications, such as clomiphene citrate (Clomid/Serophene) or letrozole (Femora). Some types of infertility may require injectable medications right from the start. Injectable medications called gonadotropins may include FSH, LH, HCG or combinations of all of these. Fertility drugs can cause mood swings and may increase your risk of multiple pregnancy (twins, triplets, or more). Infrequently, they can cause ovarian hyperstimulation, a painful condition of ovarian enlargement. There have been reports that these medications may increase the risk of ovarian cancer. However, the available data does not indicate any additional risk of future cancers like breast, ovarian or uterian. Some studies suggest that they may increase the risk of ovarian cancer, although other studies refute those findings. Patients using fertility medications should be closely monitored with ultrasounds of the ovaries to measure follicle growth/egg development and the thickness of the uterine lining. Hormone blood tests are also performed.
For women who are already ovulating but are not conveiving, superovulation is the goal. This will help create more mature eggs each month. Superovulation may be prescribed for patients with unexplained infertility, those who have had unsuccessful surgical treatment for mild endometriosis, or for patients with a mild male factor infertility. In some cases, superovulation may be used in a preliminary manner, after the patient’s infertility workup but before the initial laparoscopy. If the medication is successful in producing adequate ovulation, diagnostic laparoscopic surgery may be avoided altogether. The objective of superovulation is to stimulate the production of two to four eggs, increasing the chances for conception. In many cases, superovulation is combined with intrauterine insemination (IUI).
For women who do not ovulate, several strategies can be used to induce ovulation. Once these women ovulate, their chances of pregnancy is similar to women who ovulate naturally. Diet, exercise and medications such as Melformin or Myoinositol may help them to ovulate. If those medications do not work, Clomid or Femara may be recommended. Over 60 percent of women will ovulate with those medications. For the remaining 40 percent, fertility shots will almost always cause ovulation.