Problems with ovulation account for 40% of infertility in women and result in the ovary’s inability to release an egg. Irregular, infrequent or absent menstrual cycles are classic symptoms of ovulation dysfunction. Ovulation induction is designed to stimulate the growth and release of an egg each month so that conception can occur.


The goal of COH is to increase the chance of conception by increasing the number of developing follicles each month. The eggs grow within the follicles and are released at ovulation. Medications are taken during certain days of the cycle to increase (to 2-3) the number of eggs ovulated or released that month. Controlled ovarian hyperstimulation is often combined with intrauterine insemination (IUI) for couples diagnosed with unexplained infertility.


Oral medications such as clomiphene citrate (Clomid) and letrozole (Femara) work by either lowering the estrogen levels in the brain or making the brain think the estrogen levels are low. Low estrogen levels tell the pituitary gland in the brain to produce more FSH which stimulates follicles and eggs to grow and develop.

​If oral medications are not sufficient, injectable medications called gonadotropins (Follistim or Gonal-F) may be added or used alone to stimulate a few follicles to develop. The injections are subcutaneous (Sub Q), like an insulin injection, and are easy to administer to yourself.

Use of these medications requires monitoring (ultrasound) of the ovaries to determine when optimal follicle size is reached (for the IUI) and to adjust the medication dosage if needed.

The risk of multiple pregnancy (twins) when gonadotropins are used is approximately 25% and with the oral medications about 5-8%. The risk of triplets or higher is less than 1% with either of the medications.

Treatments: Family Balancing