Ovulation induction is performed for the treatment of infrequent, irregular or absent ovulation. Since disorders of ovulation accounts for 40% of the causes of infertility in women ovulation induction is by far the most common treatment performed.
Clomiphene citrate (Serophene or Clomid) is the most common medication used for ovulation induction, and has been in clinical use since 1967. It is taken orally and is quite effective in inducing ovulation. Approximately 80% of women who are not ovulating will respond to clomiphene citrate, and half of the women who ovulate will achieve a pregnancy.
The risk of multiple pregnancies (mostly twins) with clomiphene citrate is approximately 6%. This medication is usually well tolerated, but common side effects are transient hot flushes and mood swings. Severe complications are rare with clomiphene citrate.
Gonadotropin preparations are used for ovulation induction in patients who don’t respond to clomiphene citrate, and in patients with hypothalamic amenorrhea. For all practical purposes women with hypothalamic amenorrhea have no effective communication between the area of the brain that controls ovulation (hypothalamus) and the ovaries. These patients don’t respond to clomiphene citrate and need gonadotropin therapy for ovulation induction. The gonadotropins are similar to the gonadotropins secreted by the brain (pituitary gland) to induce normal ovulation.
Two types of gonadotropin preparations:
(1) Recombinant gonadotropins that are manufactured in the laboratory, and
(2) Highly purified gonadotropins that are extracted from the urine of postmenopausal women.
Both gonadotropin preparations are administered by subcutaneous injection (under the skin) and stimulate the ovaries directly to induce ovulation. The use of these medications requires transvaginal ultrasound monitoring of the ovaries to assess the ovarian response to treatment, and when needed, to adjust the dosage of the medication.
A common side effect of the gonadotropins is discomfort and or redness at the injection site. The risk of multiple pregnancies when gonadotropin therapy is used for ovulation induction is approximately 15%. The most serious complication associated to gonadotropins is Ovarian Hyperstimulation Syndrome (OHSS). OHSS is the result of an exaggerated response of the ovaries to the gonadotropins. This syndrome is characterized by enlarged ovaries, abdominal swelling (distention), abdominal discomfort, nausea and occasional vomiting. OHSS is usually self-limited and resolves spontaneously within a few days, but may last longer if the patient is pregnant. In severe cases hospitalization is needed for the management of this condition.
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