Ovulation Induction Summary for patients
What is ovulation induction?
Ovulation is the process of maturing and releasing an egg from the ovary. Ovulation disorders, such as polycystic ovarian syndrome (PCOS) which usually result in infrequent ovulation, account for a large percentage of fertility problems in women. Ovulation induction is therapy to stimulate the ovaries to release eggs for fertilization.
How is PCOS diagnosed?
Women with PCOS may have irregular menstrual cycles, increased acne and body hair distribution (hirsutism), high level of testosterone or luteinizing hormone in the blood, and ovaries with multiple small cysts on ultrasound imaging.
What is the initial treatment to promote ovulation?
The initial treatment to promote ovulation includes making positive lifestyle changes with respect to diet, exercise and behavior related to eating disorders.
What are the different treatments to induce ovulation?
To stimulate ovulation your doctor may recommend medications such as:
Clomiphene Citrate: This is the first line of treatment for women with PCOS. It is an oral medication which is prescribed for 5 days from the start of the menstrual period. It has anti-estrogen effects and promotes ovulation. Treatment is monitored carefully as it may result in a multiple pregnancy which increases the risk of premature birth and mortality.
Aromatase inhibitors: Aromatase is an enzyme important for estrogen production. Aromatase inhibitors such as Letrozole are used to treat breast cancer but also help in inducing ovulation. The advantages of Letrozole include fewer side effects and less risk of multiple pregnancies. It has also been shown to result in more clinical pregnancies and live births when compared to Clomiphene. Aromatase inhibitors are increasingly being used as first-line treatment for ovulation induction.
Insulin-sensitizing agents: PCOS is often associated with increased insulin resistance resulting in high levels of insulin in the blood. This has a negative effect on ovulation. Insulin-sensitizing drugs such as Metformin decrease blood insulin levels promoting ovulation. Metformin is an oral medication which your doctor may recommend if clomiphene alone is ineffective.
Gonadotropins: Gonadotropins such as follicle stimulating hormone may be administered as a daily injection for women who are anovulatory and resistant to clomiphene. There is an increased risk of multiple pregnancies with the use of gonadotropins so you will be carefully monitored with blood tests and ultrasound studies. If too many eggs are produced at the same time, that cycle is abandoned. Gonadotropins are usually the second-line treatment if clomiphene is not effective since oral medications are preferred first.
What are the other procedures to improve ovarian function?
Your doctor may also recommend laparoscopic surgery which is considered a second-line treatment and is as effective as gonadotropin therapy.
What if ovarian induction is unsuccessful?
In vitro fertilization is a highly effective treatment that can overcome resistant infertility due to PCOS and other ovulation disorders, and has helped many women conceive and have their own children.
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