What’s New in Ovulation Treatment of Infertility

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Medications for the increasing ovulation to help couples get pregnant are fairly commonly used. What medication to use, information about risks and multiple births, as well as the longer term consequences can be a very complex discussion. Couples are urged to have personal consultation.

  1. Ovulation medicines are given for women who do not ovulate, or are suspected to have problems with ovulation based on irregular periods.
  2. The success of ovulation medications can be improved by insemination with sperm at the time the egg is anticipated to be released.
  3. Women who take ovulation medication are at risk for multiple births, primarily twins.
  4. The success rates of these medicines are affected by other factors including whether the tubes are open, endometriosis, and even vitamin D levels.
  5. 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.
  6. Ovulation medication can be given when the cause of infertility is not yet certain. These medications may be given to women who have menstrual cycles and have not yet conceived, or women who have no menstrual periods, even for those who have PCOS.
  7. The pills for ovulation induction can be combined with injectable fertility medicines to increase the success rate.
  8. When looking at these two common medicines, clomid and letrozole, about 60 to 75% of women who are infertile due to no menstrual periods will ovulate when given these relatively low cost medications. They both 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. Because it is so safe and effective many physicians will use it very early on for infertility treatment, in the low dosage, for 1-6 cycles. Letrozole is 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 clomid, 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. Patients should also discuss with their gyno the fact that Clomid is indicated for infertility treatment, and letrozole for this indication is considered off label.

We welcome those planning pregnancy, or suffering from infertility, to come to WHP for consultation.

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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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