Ovarian Stimulation

For women that have ovulation dysfunction, Dr. Brown frequently prescribes fertility medications to stimulate the ovaries.  These medications can help regulate ovulation and may even trigger ovulation to occur.  Fertility medications can be taken orally or may be given as an injection, depending on what Dr Brown recommends.

To understand how infertility treatments work it’s helpful to review the normal processes that occur each month in a woman’s body.

Click here to see how the normal menstrual cycle works

Clomiphene Citrate (brand names Clomid and Serophene)

When a woman is not ovulating at all or is ovulating at irregular times in her cycles, we may prescribe Clomid. This medication is frequently the first choice of medications for women with ovulatory dysfunction because it doesn’t require an injection, it’s inexpensive, and has been working effectively for many years. In most patients, Clomid has an 80 percent success rate in stimulating ovulation to occur.

Clomid works by reducing estrogen production.  These low levels of estrogen can cause the pituitary glands to produce more Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) and in turn stimulate oocyte (egg) development in the ovary. This process creates many more mature oocytes than a regular cycle and makes them ready for ovulation.

Typically, a patient starts Clomid on cycle day three, four, or five, taking one 50 mg tablet for five days.  Usually, our patients will use an ovulation predictor kit after finishing the Clomid. By using the ovulation predictor kit we can see a positive LH surge and know the ovulation has occurred. The side effects of Clomid are very tolerable and may include the following :  

Common side effects of Clomid :

• hot flashes
• ovarian enlargement with bloating and abdominal distention
• nausea
• vomiting
• headache
• abnormal uterine bleeding

 If no LH surge is observed, you did not ovulate in this cycle.  For the next Clomid cycle we will adjust the dose and try again.

Don’t worry. Remember 80% of women ovulate on Clomid; Dr Brown just needs to find the right dose for you!

Gonadotropins

Normally produced by your pituitary gland, gonadotropins are an important part of the conception process. These hormones, consisting of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), are what help the ovaries to produce a mature follicle, containing the oocyte, which your body releases in hopes that fertilization will occur.

Extra gonadotropins can be given as part of infertility treatment. With carefully monitoring and dosages, these hormones can help a woman to produce more than one mature follicle (containing the oocyte) for ovulation. Gonadotropins, when used in combination with intrauterine insemination (IUI), have proven to be a very successful infertility treatment option.

Several different types of gonadotropins exist. HMG (Bravelle/Repronex) are made out of highly filtered urine of post-menopausal women. When in menopause, women excrete large amounts of gonadotropins which can be collected and purified for injection.

The second type of gonadotropins is recombinant FSH: Follistim and Gonal-F. These medications are produced in pharmaceutical labs under meticulous control and are highly purified.

Each of these medications will work for ovarian stimulation, but specific situations may require different medications. Dr. Brown will choose the best medication regimen for your particular situation and in some cases may change the medications from cycle to cycle depending on the results.

With a Gonadotropin cycle you will need to contact the office on cycle day one or the first day of a full menstrual flow. Our office will schedule an ultrasound to look for any ovarian cysts you might have in your ovaries that might disrupt the cycle. After confirming that no cysts are present, you will be started on the stimulation medications. Gonadotropins are very strong medications that require frequent monitoring to ensure your body responds appropriately.  Upon starting the stimulation, you will visit the office every few days for blood work and ultrasounds. When several follicles reach maturity, we will prescribe an injection of Human Chorionic Gonadotropin or HCG that will trigger ovulation. This is injection is also called a “Trigger Shot”.

Following the trigger shot, the intrauterine insemination (IUI) will occur or in some case you will move to IVF and we will remove your eggs. The side effects from stimulation with gonadotropins are common, but not limited to:

• bloating
• slight abdominal discomfort,
• multiples pregnancy
• and in rare instances ovarian hyperstimulation syndrome (OHSS)

Most patients will experience the mild form of OHSS, which consists of a bloating sensation; less than one percent experiences the severe form that may require hospitalization. Dr. Brown will monitor your progress very closely to minimize the risk of side effects while ensuring that a high success rate.