What is "ovulation induction"?
One of the main causes of female infertility is the lack of ovulation. Ovulation is a very complicated cascade of events that we take for granted, like so many things in the world, that results in the production of an egg in the woman's ovary, and then a release of that egg so that the egg can be picked up by the fallopian tube and then be fertilized. If this is not happening, we can augment the process by stimulating the ovary to release the egg.There are two general classes of medications that are available for this. One class of medication stimulates the body to make more of a particular hormone called FSH, follicle stimulating hormone. The body that makes the FSH, and the FSH stimulates the ovary to cause ovulation to occur. These medications are typically given in pill form, and they consist of clomiphene or Clomid, tamoxifen. There are the aromatase inhibitors. All of these drugs work the same way. They are given orally, they fool the body into thinking there is less estrogen than there should be, and the body makes more FSH, and causes the woman to ovulate. The majority of women with a condition such as polycystic ovary syndrome, PCOS, will ovulate in response to these oral agents. However, if these do not work, we have to move on to injectable medications. Injectable medications essentially are injectable FSH, follicle stimulating hormone, which is the hormone that stimulates the follicle to grow and then to release the egg. Injectable FHS can be given in a variety of doses, again, to help the ovary produce the egg. The trouble with FSH injections is, first of all, they are expensive. The woman has to take daily injections, and it's quite difficult to control the production of a single egg. Most commonly, we get the production of multiple eggs. This is good if you're doing high-tech fertility, but it's not so good if you're doing ovulation induction, where you really don't want the woman to have more than one baby at a time. So it's pretty tricky to control the dose just right to get her to ovulate that single egg. For this reason, that patient is required to have ultrasounds, blood tests, and so on, to monitor her response in the ovaries, whereas the orally active agents like clomiphene or tamoxifen typically do not require that type of monitoring. The patient can take the pill at home and then simply have intercourse at the time of ovulation.
