There are two main oral fertility medications for ovarian stimulation, oral and injectable
Clomiphene citrate, Clomid®, Serophene®
This is a pill that either stimulates ovulation to occur in women who do not have regular menstrual cycles, or stimulates the ovulation of more than one egg at a time in women who already ovulate on their own. Clomid is an anti-estogen that works by essentially fooling the brain into thinking that very little estrogen is being produced by the ovaries. As a result, a part of the brain called the hypothalamus sends a signal to the pituitary gland. In response, the pituitary secretes follicle stimulating hormone (FSH) that goes through the circulation to the ovaries to stimulate egg development and estrogen production. Clomid can be successfully combined either with intercourse or insemination (IUI) – depending on the quantity and quality of your partner’s sperm. Some women experience hot flushes, headaches, night sweats, and occasional irritability while taking Clomid. This medication can also thin the uterine lining in some women, so Dr. Munch and Dr. Hudson will be careful to measure the thickness of your endometrium approximately five-six days after your last clomiphene pill to make sure that it is thick enough to support a developing pregnancy.
Femara is another type of pill that is used to stimulate egg development in the ovaries. Some women who don’t respond to Clomid will have better luck with Femara. Also, women who have a thin lining due to Clomid may not have the same side effect while taking Femara.
These treatments involve an ultrasound performed on cycle days #3, 4, or 5 (baseline ultrasound), followed by five daily doses of Clomid or Femara, and another ultrasound performed 5 or so days after the last pill (midcycle ultrasound). In the event that the ultrasound reveals good follicular development and an adequate endometrial thickness, an ovulation prediction kit will be used to detect the LH surge (the hormonal surge that triggers ovulation to occur). Alternatively, some women may be given an injectable medication (Ovidrel®) to cause ovulation to occur.
Once we know when ovulation will occur, intercourse or uterine insemination can be scheduled.
Unlike Clomid or Femara that stimulate the production of FSH, gonadotropins actually are FSH. They act directly on the ovaries to stimulate egg development. As they are more potent than either Clomid or Femara, gonadotropins generally cause maturation of more eggs than Clomid and therefore carry a higher risk of twins and higher order multiple pregnancy.
This treatment involves an ultrasound on cycle day #1, 2, or 3 (baseline ultrasound), to ensure that there are no residual ovarian cysts from the most recent cycle that could interfere with egg development. If no cysts are present, you will begin taking shots each night starting on cycle day #2 or 3. A vaginal ultrasound and blood estrogen test will be performed every 2-3 days during egg development (to enable us to adjust the dose of medication if needed). Finally, a trigger shot medication will be administered to cause ovulation to actually occur.
Unlike with Clomid or Femara, data show that pregnancy rates are significantly higher when we combine IUI with gonadotropins rather than intercourse. In addition, a landmark study performed by TFC doctors demonstrated that 2 IUIs (one on each of 2 consecutive days) are more effective than a single IUI when patients are taking gonadotropins.
Examples of gonadotropin medications: Gonal-F, Follistim, Menopur
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