Carolinas HealthCare System

About one-third of infertile patients experience abnormalities with the ability to produce mature eggs or release the eggs (ovulation).  Commonly known as fertility drugs, ovulation induction medications can be taken either orally or through injections to stimulate a woman's ovaries to release multiple mature eggs. Ovulation induction may be recommended to correct ovulation disorders or produce several eggs (superovulation), especially in patients with unexplained infertility, advanced age or when other treatments have proven unsuccessful. This improves chances for fertilization and ultimately pregnancy.

Since these medications also control the time that ovulation occurs, fertilization can occur either naturally through sexual intercourse, or via intrauterine inseminations or other in vitro procedures at the time that is most likely to result in conception. The most common oral medications are Clomiphene Citrate (Clomid, Serophone), Glucophage (Metformin), and Bromocriptine (Parlodel). Common injections are Gonadotropins (Pergonal, Repronex, Menogon, Fertinex, Follistim, Gonal F, Puregon, Pregnyl, Novarel, Profasi, Ovidrel).

Success rates vary depending on the method of ovulation induction used to treat the infertility, though in general they are high. Risks include increased chances of multiple births and ovarian cysts, both of which are reduced by closely monitoring patients.

Based on testing done at the initial consultation, our reproductive specialists will determine if this is the best method of treatment for your unique situation.

Clomiphene Citrate

Clomiphene citrate--often a first line treatment for couples with unexplained infertility--is an oral medication that stimulates ovulation in women with irregular cycles. The medication is generally given for five days of each menstrual cycle (days three through seven), and ovulation usually occurs about a week after the last tablet. Ovulation may be monitored by ultrasound and blood testing (progesterone levels). At ovulation, either intercourse or intrauterine sperm insemination may be recommended. The lowest ovulation-inducing dose is generally recommended, since increasing the dosage generally increases side effects without improving ovulation. The most frequent side effects are hot flashes, nausea, breast tenderness and headaches. Fertility medications increase the risk of multiple pregnancies. The chance for twins with clomiphene citrate is about 8 percent and rarely do more than twins occur. Generally, clomiphene citrate is used for four to six cycles. If unsuccessful, other options are considered, including superovulation treatment.

Superovulation Treatment 

Superovulation treatment will stimulate the growth of several follicles in the ovaries to induce the formation of more than one or two eggs per cycle, enhancing pregnancy odds. Daily injections of FSH and/or hMG begin around the third day of your cycle and continue for approximately six to 10 days. Ultrasound and bloodwork are used to confirm appropriate response. The monitoring typically requires four or five visits before ovulation, although additional monitoring may be advised. The most common side effects of the medication include abdominal bloating, breast tenderness and mood swings. In 80 percent of pregnancies that occur following superovulation treatment, a single intrauterine pregnancy will result, but it increases multiple pregnancy risk. Closely monitoring response to the medication can decrease this risk.

Intrauterine insemination may be recommended in conjunction with clomiphene citrate or superovulation and will often be recommended for couples with male factor infertility. Intrauterine sperm insemination is a specialized procedure during which a catheter is passed through the cervical canal to deposit washed sperm within the uterine cavity. The goal is to provide motile sperm with an increased number of eggs and enhanced chance of pregnancy