- Hormonal treatments are used to help women ovulate or to help them “super-ovulate”, ovulate more than one egg.
- Women who do not ovulate spontaneously and have normal estradiol levels are traditionally prescribed Clomiphene Citrate, or Clomid.
- This medicine is a partial estrogen and partial anti-estrogen
- For women who don’t ovulate spontaneously, 80% will ovulate with clomiphene and 50% will conceive.
- Clomiphene Citrate is associated with multiple follicle growth, so twins and triplets may occur, 20% of pregnancies may be multiples.
- This medicine can have side effects such as hot flashes, sensitivity to light, headaches and mood swings.
- Also, sometimes the cervical mucus is drier and thicker and sometimes the inside of the uterus doesn’t grow as thick as it should.
- Both medicines are pills taken for 5 days after the start of a period.
- The pills are started between day 2 and 5.
- Dosage starts at one pill and can be increased in subsequent cycles to 2 pills or 3 pills as needed/
- Ovulation typically occurs one week after the last pill but may be later than that.
- For heavier women a higher dose or longer dose for up to 7 days may be the initial dose.
- For those with associated high testosterone levels, sometimes a low dose steroid, dexamethasone, can be added to the regimen to increase fertility
- Insulin sensitizers such as metformin can also be added.
- When oral pills do not directly induce follicular growth, the next step has been ovulation induction with injectable pituitary hormones including FSH or a FSH/LH combination.
- The oral medications work by “tricking” the pituitary to produce more FSH to stimulate the ovary to make follicles.
- When this stimulus isn’t strong enough, the injectables provide the FSH directly to the ovary.
- These are usually successful but may produce multiple follicles.
- If there are too many follicles and the risk of multiple gestations is too high, then the cycle needs to be cancelled or converted into an IVF cycle where all the eggs can be removed and then we control how many embryos get transferred back in.
- Depending on the individual, doctors may use a combination of pills and shots that ultimately has a cost advantage and may work better than pills alone.
Dr. Chudi