Once one of our doctors has determined the source of their patient's fertility troubles, he or she may recommend a procedure called ovulation induction or super-ovulation to help the ovaries to produce more eggs. This treatment is usually performed in conjunction with intrauterine insemination in order to optimize the exposure of the ovulating egg(s) to sperm
How ovulation induction works
A woman's ovaries contain hundreds of thousands of follicles or sacs, each containing an egg. In a regular menstrual cycle, one follicle will mature, eventually releasing its egg from the ovary (this is ovulation).
For women with ovulatory problems, the first step is usually oral medications such as clomiphene citrate (Clomid) or letrozole (Femara). These oral fertility medications, taken from days 3-7 of a natural or provera-induced period, will cause most women to recruit at least one (possibly 2 or 3) eggs.
How super-ovulation works
With the help of hormone therapy, the ovaries can be stimulated to produce multiple eggs rather than just one. This is particularly useful for patients 35 years old and older because in the late 30's and 40's, fewer eggs will have normal chromosomes so we wish to recruit multiple eggs to develop in hopes of finding a normal egg or two. Here are the steps involved in this process.
Keep in mind that a PFC doctor and our nursing staff will be by their patient's side every step of the way:
- When a woman has a period, her doctor will perform an ultrasound exam to assess ovarian health and to make sure that there are no ovarian cysts that may be present from the prior month's ovulation.Clomid
- After her menstrual period, she will begin either oral medications Clomid or Letrozole OR daily injections of natural, egg-recruiting hormones. (Names of these hormones include: Gonal-F, Bravelle, Menopur and Follistim).
- Another one or two ultrasounds will be done during the cycle to see how many follicles are developing and to determine when the egg(s) are ready to be triggered to be released from the ovaries. If they are, she will stop taking hormone medications.
- The patient will receive just one injection of a hormone called human chorionic gonadotropin (Ovidrel) that will cause the egg(s) to be released about 38-40 hours later and to mature the egg(s) for fertilization.
- 36 hours after the Ovidrel injection, she is ready for the intrauterine insemination.
- The insemination involves a painless procedure and involves placing a sample of partner's washed sperm or frozen-thawed donor sperm up into the top of the uterus using a thin flexible tube. Learn more about IUI.
- If the woman has a husband or male partner, it is okay to have intercourse following the insemination.
- In most cases, she will be prescribed micronized progesterone tablets to insert into the vagina for extra support to the uterine lining for the implanting embryo.
- Vaginal progesterone will be continued until the first pregnancy test two weeks later.
- If the patient is pregnant, she will continue the progesterone to help support the early pregnancy until at least the first obstetric ultrasound, performed 5 weeks after the insemination.