Treatments

Clomiphene Ovulation Induction

Ovulation Induction is used to treat women with ovulatory problems or to regulate their menstrual cycles. The medication first prescribed is "clomiphene citrate" which is taken orally.  Clomiphene stimulates the brain center which controls the pituitary gland to release the hormones which control the ovary.  These pituitary hormones are: FSH (Follicle Stimulating Hormone), which is necessary for the growth of the follicles which contain the "eggs" and LH (Luteining Hormone)  responsible for  ovulation, the release of the eggs.  During the course of treatment the patient usually undergoes a transvaginal ultrasound to insure proper development of the uterine lining and the ovarian follicle(s) that will ultimately release its mature egg. Inseminations (see IUI below) may also be done in conjunction with clomiphene therapy. If the clomiphene medication is not successful after 3 to 6 cycles, then  FSH itself may be prescribed to be administered by daily injections.

Injectable Medications (HMG, FSH)

FSH (Follicle Stimulation Hormone) therapy is used in women having absent or irregular menstrual cycles to induce ovulation. The therapy is self-administered by daily injections with a very small needle, (similar to the one used for insulin injections). The medication is identical in structure to FSH produced by the human pituitary gland, one of  its main actions is to stimulate the growth of ovarian follicles and allow for the eggs within these follicles to mature.

Once the follicle reaches the appropriate size, an additional hormone (LH) is required to stimulate the release of the egg from its follicle. Human Chorionic Gonadotopin (HCG) is a natural hormone which has LH- and effectively induces the final step of ovulation, i.e. the release of a mature egg ready for fertilization. If Intrauterine Insemination (IUI) is chosen in conjunction with FSH therapy, it is done approximately 24-36 hours after the administration of HCG.

Unfortunately, FSH injections' principle side effect is the over stimulation of the ovaries, i.e. too many follicles mature and the ovaries become cystic and significantly enlarged. This can result in an assortment of medical problems for the mother as well as multiple fetuses, should pregnancy occur. Therefore, patients receiving this therapy need to be closely monitored with frequent blood tests (estradiol levels), and examinations with transvaginal pelvic ultrasounds. This careful monitoring can usually avoid these serious complications of FSH therapy.

Intrauterine Insemination (IUI)

Artificial insemination may be done during a natural menstrual cycle or in conjunction with ovulation induction medications; its indications may include such cases as when the semen analysis of the man is subfertile, if he has ejaculatory problems or when the woman has decreased or absent cervical mucus. The semen sample is processed in our laboratory to extract the motile sperm for the insemination procedure, called IntraUterine Insemination. By using a small catheter which passed through the cervix just prior to the time of ovulation, the mobile sperm are placed directly into the uterine cavity of the uterus. The success of this treatment is dependent of the woman having normal pelvic anatomy and the insemination sample having more than one million motile sperm. If either of these criteria is not be present or if the treatments do not result in a pregnancy after 3 or 4 cycles, IVF is then recommended.