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Ovarian Stimulation

Ovarian stimulation with Clomid or injectable fertility medications creates normal or accelerated ovulation

Ovarian stimulation is a common part of many fertility treatments. For women who have absent or irregular menstrual cycles, ovarian stimulation can help to create regular ovulation.

For women who already have regular menstrual cycles, ovarian stimulation can help to increase the odds of more than one egg releasing to increase the odds of pregnancy.

Ovarian stimulation is often done in conjunction with IUI (intrauterine insemination) or with the process of in vitro fertilization (IVF).
Either oral or injectable medications can be used to stimulate the ovaries.

The most common oral medications that are used are clomiphene citrate (otherwise known as Clomid™ or Serophene™) and letrozole (otherwise known as Femara™). These medications are generally taken for approximately 5 days early in the menstrual cycle. It is common to develop 1 mature follicle (i.e., 1 mature egg) with this kind of treatment, but occasionally, multiple eggs may be released. Most pregnancies that result from this type of treatment are singletons, though there is a low chance of twins (up to ~4-8%), and a remote chance of triplets or higher (~1 in 3000 cases). An ultrasound or an ovulation kit can then be used to document ovulation.

There are many different brands of injectable fertility medications or gonadotropins.

The most common ones used at Texas Fertility Center are Follistim™, Gonal F™, and Menopur™. Because these medications are more ‘potent’ than oral medications, they do require more monitoring with ultrasounds and blood work (i.e. estradiol levels). These medications are commonly used for between 7-12 days, but this can vary depending on an individual’s sensitivity to the medication.

Though the majority of pregnancies from this type of treatment are singleton, there can be a chance of twins – and occasionally more. Injection lessons are available for patients to learn how to use these medications.

Patients who do not ovulate in response to oral medications alone may benefit by what’s called a ‘hybrid cycle’. In this scenario a combination of oral medication and a small amount of injectable hormone is used to stimulate the ovaries. The use of oral medications in conjunction with injectable medication may help to lower the amount of injectable medication needed, thus decreasing the cost of the treatment cycle.

Injectable medications are an important component of IVF, in vitro fertilization cycles. By using these kinds of medications, multiple eggs can be stimulated to mature. It is ideal to have a number of eggs to work with to increase the odds of there being a ‘good egg’ to work with. Also, having multiple eggs increases the odds of having excess embryos that can be frozen for later use. The chances of twins (or higher) does depend significantly on the number and quality of embryos (fertilized eggs) that are placed in the uterus.

In summary, ovarian stimulation is an integral part of many types of fertility treatment and can be used to create regular ovulation or to increase the numbers of eggs that can mature.

Dr. Tony Propst discusses fertility medications for ovarian stimulation

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