If you have problems with ovulation, you may have difficulty getting pregnant. Ovulation induction is often the first fertility treatment doctors will try for irregular or absent ovulation. This procedure involves the use of hormonal medications to help your ovaries release eggs.
At UPMC, our fertility specialists offer ovulation induction to help you become pregnant and build your family. It may be the only treatment you need, but we can also combine ovulation induction with other cutting-edge fertility therapies.
Here’s what you need to know about this common fertility treatment.
Ovulation induction is a treatment for people who have trouble ovulating. Doctors also call it ovulation stimulation, and you may also hear this process referred to as “taking fertility drugs.”
These drugs stimulate the release of the hormones that trigger egg production.
If you have regular periods each month, you’re probably ovulating regularly. But if your periods are irregular, chances are ovulation is, too.
Ovulation induction helps you become more fertile by helping regulate your ovulation pattern. It can be especially helpful if your menstrual cycles (and therefore ovulation) are irregular.
For those who don’t ovulate at all, or who have unexplained infertility, ovulation induction can also be a path to pregnancy.
You're born with about one to two million immature eggs in your two ovaries. Most die off naturally, but by puberty, about 400,000 eggs remain. Once you have menstrual periods, an egg is released from the ovaries once a month.
Ovulation occurs about 14 days before the first day of each menstrual period. It happens when a follicle — the fluid-filled cysts in the ovaries that contain the eggs — releases a mature egg. The egg moves into the fallopian tube, where it mixes with sperm.
There’s a “fertile window” of six days when you can get pregnant. If the egg gets fertilized, it becomes an embryo and travels into the uterus. When the embryo implants in the lining of the uterus, you become pregnant.
When your ovulation is irregular, it can be difficult to know when your fertile window is. And if you’re not ovulating at all, pregnancy is impossible. About 25% of those who struggle with fertility have problems with ovulation.
Ovulation induction medications can help you ovulate on a more consistent, predictable schedule, increasing your chances of getting pregnant. These drugs also improve the lining of the uterus, making it more hospitable to an embryo.
There are two types of ovulation induction medications.
These medications are usually the first drugs doctors recommend if you don’t ovulate, or ovulate irregularly. The most common fertility drug is clomiphene citrate (Clomid), which works by causing the pituitary gland to make more follicle stimulating hormone (FSH).
Another common fertility drug is a group of medicines known as aromatase inhibitors. Doctors originally used them to treat breast cancer but found that they also promote ovulation.
Injectables are the next step if oral fertility drugs don’t work. Doctors give an injection just under the skin to boost follicle growth in the ovaries.
These injectable drugs are gonadotropins. They contain FSH or luteinizing hormone (LH), another hormone that stimulates ovulation.
Doctors also use these medications if many eggs are necessary for in vitro fertilization (IVF). If you’re going to freeze your eggs or embryos, it’s advantageous to produce multiple mature eggs at one time. The hope is that at least one egg will get fertilized and lead to a pregnancy.
You might need ovulation induction if you have irregular or missing periods and therefore irregular ovulation.
Reasons you might have irregular cycles or no menstrual periods include:
Ovulation induction is also a component of IVF. This is because having more eggs gives you better odds of one getting fertilized and resulting in pregnancy. You can freeze multiple eggs or use them in IVF right away.
Ovulation induction can also be a treatment for unexplained infertility. Doctors generally don’t recommend ovulation induction if there's another known cause of infertility, such as blocked fallopian tubes.
Ovulation induction is a treatment for those who:
Your doctor can talk to you about alternatives to ovulation induction. Sometimes lifestyle changes alone can boost your fertility.
To prepare your body for pregnancy:
There are some risks and complications to taking fertility drugs. Some people experience temporary side effects similar to those of menopause.
The most common complication of using fertility drugs is ending up with twins, triplets, or other multiple births. The risk is highest if you use gonadotropins, which are injectable fertility drugs.
With oral medications like Clomid, the chance of having twins is 5% to 8%. The chance of having triplets or more multiples is less than 1%.
With injectable fertility drugs, you're more likely to have multiples. Up to 30% of pregnancies stimulated by gonadotropins are multiples. Of those, about two-thirds are twins, and a third are triplets or more.
Carrying and delivering multiples puts you at greater risk for:
Other potential complications of ovulation induction are:
Doctors have used ovulation induction as a fertility treatment for decades. There's no evidence of an increased risk of birth defects, ovarian cancer, or other serious side effects.
What to expect will depend on which kind of ovulation induction treatment you have. The preliminary exam and testing are similar whether you’re receiving oral or injectable ovulation induction.
You'll go to your doctor’s office for a physical exam. Your doctor will ask about your medical history and your fertility history. You don’t need to do anything special to prepare for this appointment.
Your doctor may require some tests before recommending fertility drugs.
They may want to make sure your fallopian tubes aren't blocked before starting ovulation induction. Blocked fallopian tubes won't allow sperm to reach a mature egg. Doctors can check your fallopian tubes by injecting dye into them or using a lighted telescope to look inside the lower abdomen.
Your partner should also have a semen analysis before you start fertility drugs. Knowing the quality and quantity of his sperm will help your doctor advise you on further steps to take.
You'll take oral fertility medication for five to seven days.
If you’re getting injections, you’ll have them for eight to 12 days.
Your treatment may depend on what kind of fertility drugs you're receiving. It also may depend on why you’re having the treatment, for example, whether you're regulating ovulation or increasing your egg supply for IVF.
Doctors will usually start with oral medications to boost egg production. If oral medications aren’t successful, they’ll recommend moving to injectable medications.
The treatment cycle begins on the third day of your menstrual cycle.
Your doctor will do baseline testing to make sure you’re not pregnant. You'll also have an ultrasound and bloodwork in the office. If the ultrasound is normal and you’re not pregnant, your doctor will tell you when to start taking your medication.
You’ll take Clomid (or another oral fertility drug) between days three and seven or between days five and nine of your cycle. Your doctor will give you a precise timeline for taking the medication.
On day 10 or 11, your doctor will perform an ultrasound to check for egg development. They'll be able to see the follicles with the ultrasound and tell if they're developing normally.
You may combine ovulation induction with timed intercourse, IVF, or intrauterine insemination (IUI), where sperm gets placed directly in the uterus. Your doctor can tell you when you should start attempting to conceive naturally or have IUI.
You can monitor ovulation at home with an over-the-counter ovulation predictor kit. You should have sex on the days the ovulation kit shows that you’re most fertile.
You should take a home pregnancy test two weeks later.
If oral medications don’t work, the next step is to try gonadotropins, which are injectable fertility medications such as FSH. The treatment begins the same way as oral fertility drugs — with an ultrasound and bloodwork on the third day of your menstrual cycle.
Doctors will start injectable treatments on day three. They'll continue for six to 10 days, depending on how your body responds. You may give yourself the injections or have someone else give them to you at home.
During that time, you may have several more ultrasounds and blood tests to monitor follicle growth.
Once a follicle measures 16 to 18 millimeters in diameter, your doctor will give you instructions on giving yourself a different injection. This shot is human chorionic gonadotropin (hCG), and it triggers ovulation. You should have sex or an IUI soon after the injection.
You should take a home pregnancy test two weeks later.
It’s not common to have serious side effects from ovulation induction.
But you should call your doctor if you have:
These could be signs of ovarian hyperstimulation syndrome (OHSS), which is a condition where the ovaries swell and become painful. OHSS requires medical treatment.
The success rate of ovulation induction depends on many factors. One of the most important is your age. A woman’s overall fertility rate drops dramatically in her mid-30s, and further at age 40.
However, nearly 30% of all couples achieve a successful pregnancy through just one cycle of treatment with fertility drugs. With multiple cycles, about 45% achieve a successful pregnancy.
The experts at UPMC tailor your fertility treatment to your specific needs. Our specialists can help you select the ovulation induction approach that gives you the best chance of conceiving.
We offer a woman-focused approach to fertility and reproductive health care. Our doctors have the knowledge and expertise to provide highly personalized health care, from evaluation and diagnosis to treatment. If you have a medical condition that’s contributing to infertility, we can help.
Our doctors and other medical experts also take a team approach to fertility care, pulling in specialists from related fields when needed. The couple is always at the center of any fertility decision.
We also inform you about the details of any fertility procedure or treatment we might offer. That includes the cost for those procedures not covered by insurance, and various payment plans we offer.
Last reviewed by a UPMC medical professional on 2024-09-05.
