Infertiilty treatment for women with ovulatory disorders

Infertility treatment for women with ovulatory disorders

Ovulation induction (OI) treatment attempts to stimulate the hormonal pathways to release an egg from the ovaries. Medications used to induce ovulation include clomid, FSH, HMG, and hCG.

Clomid. clomid is the first line of oral treatment to induce ovulation. Clomid stimulates the pituitary gland to release gonadotropins FSH and LH, which are required to develop a follicle and ovulate. Clomid has a high rate of ovulation induction for women with normal estrogen and FSH levels. Clomid is also indicated for women with polycystic ovary syndrome (PCOS) but does not respond well for women with low estrogen (i.e. hypogonadism, hypothalamic amenorrhea).

For women with amenorrhea, progesterone is often given to induce menstrual bleeding. Clomid is then taken on day 3-5 for 5 days. During treatment, regular ultrasounds are taken to monitor follicular development. Ovulation prediction kits or blood tests can help with the timing of ovulation, which occurs around day 14 to 19.

FSH (Gonal-F, Bravelle). FSH is a gonadotropin that stimulates the ovaries to develop and release a mature egg follicle.

hMG (Repronex, Menopur). hMG injectable medication that contains the gonadotropins FSH and LH. hMG also stimulates the ovaries to induce ovulation. hMG is for women with low estrogen and low gonadotropins levels (hypothalamic amenorrhea or hypogonadotropic hypogonadism).

Risks of hMG include a 25% chance of multiple births. To reduce the risk, a cycle of medication may be stopped if there are too many active follicles.

Ovarian hyperstimulation syndrome (OHSS) is also a risk factor for hMG therapy, which causes an enlargement of the ovaries. Patients more at risk for OHSS include younger women with polycystic ovarian syndrome.

hCG. hCG is a hormone that resembles the gonadotropin LH surge. Normally, a surge in LH will trigger ovulation in women. Women are typically given clomid or hMG before taking hCG medication. Ovulation occurs 24 to 48 hours after taking hCG.