Our Gyno Health

Get Pregnant By Improving Ovulation

The most common cause of female infertility is lack of consistent ovulation.

Regardless the cause of the lack of ovulation many women respond to one of two common fertility treatments: Clomiphene Citrate (most often given as the medication Clomid) and letrozole (the breast cancer treatment Femara) are both effective fertility treatment due to the stimulation of ovulation.

It is possible to tweak dosages of these ovulation medicines, combine them with other medications, or these two medicines may be given to women who have menstrual cycles and have not yet ready to get pregnant but have an inkling they may want to try for pregnancy soon, or women who have no menstrual periods, or for those who have PCOS.

Although the medications for ovulation induction work to help you get pregnant, effectiveness is modest. About 60 to 75% of women who are infertile due to no menstrual periods will ovulate when given these relatively low cost medications.

The medications for ovulation induction work by signaling there is low estrogen and thus more hormones are released to increase the number of eggs ovulated. Clomid is a SERM. Selective Estrogen Receptor Modulators (SERMs) could bind to the estrogen receptor to stimulate estrogen properties or to counter them. For fertility we make use of the fact that Clomid medication binds to the surface of cells the pituitary gland and thus pushes the hormonal factors to produce more growth of the follicle that will eventually produce a fertile egg.

Some side effects from ovulation medications are not uncommon, and it’s important to go over those with your gyno.

Because there are few serious side effects, and statistically very safe for both mom and babies (and effective), many physicians will use it very early on for infertility treatment, in the low dosage, for 1-6 cycles.

Letrozole is is in the category of medicine called an aromatase inhibitor, essentially blocking the production of estrogen and making estrogen levels transiently very low . It may be better than Clomid based on some recent studies at the University of Nottingham in Derby, England. Dr. Saad Amer who headed these studies also believed there were fewer fetal anomalies with letrozole than with clomifene, however the rates of birth defects were only slightly higher than the rates of birth defects in women who did not use these medications. When women take these medications potential side effects, other than the side effects of the medication administration, include twining, preterm birth, miscarriage, or tubal pregnancy.

Some physicians use very close monitoring of the medications, but others merely recommend timing of sex with ovulation after taking an ovulation medicine, and others will order both an ultrasound and plan inseminations with your partner’s sperm.

Most gynos will have you try for pregnancy without medication first, so go in for an appointment to pregnancy plan and decide when it is appropriate to intervene further.

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Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

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