Ovulation induction helps women who don’t ovulate or have poor ovulation

Approximately 30-40% of cases of infertility are due to problems with ovulation. Women who have irregular menstrual cycles generally do not ovulate. A normal menstrual cycle length is anywhere from 26 days to 35 days long. If you are having bleeding more often than every 26 days or farther apart than every 35 days, you might not be ovulating regularly. While it is common – and even potentially normal – for women who ovulate regularly to occasionally skip a cycle, if this happens with any degree of irregularity, it may well indicate a problem. There are some basic hormonal tests that can be performed to determine if ovulation is occurring, as well as to determine the cause of a problem with ovulation.

Hormonal tests that may identify the cause of ovulatory dysfunction

• ovarian reserve testing (AMH and FSH)
• thyroid tests (TSH)
• prolactin level
• androgen (male hormone) levels

When women do not ovulate regularly, we prescribe a procedure called “ovulation induction”. Ovulation induction involves the administration of medications designed to either correct or override the problem that is causing ovulation to not occur regularly. Typically the first treatment that we use to cause ovulation is a pill, either Clomid or Femara. Ovulation is actually controlled by your brain. If the signal from your brain to your ovaries is not being sent correctly, Clomid and Femara can improve the signal and initiate ovulation. If pills are not successful at causing ovulation then injectable medications, called gonadotropins, are tried next. These shots consist of follicle stimulating hormone (FSH), the hormone that the brain produces normally to make ovulation occur from the ovary. So if Clomid or Femara fail to get the pituitary gland to send the proper signal to the ovaries, we can override this process by giving you FSH, which will act directly on the ovaries to cause follicular development and ovulation to occur.

Ovulation induction medications can also help women who do ovulate.

Women who have regular menstrual cycles can also benefit from ovulation induction medications. Although these women are already ovulating, they frequently will benefit from super ovulation, meaning that they will ovulate more than one egg. With ovulation induction medications, it is possible to cause 2 to 4 eggs to ovulate, improving the chance for pregnancy (but also raising the risk of a multiple pregnancy).