Ovulation induction (OI): the basics

Ovulation induction (OI) is a fertility treatment that uses medications to stimulate the ovaries to release eggs (ovulation). OI is used for women who have problems with ovulation and to help with assisted reproductive technologies such as IVF (in vitro fertilization) or IUI (intrauterine insemination). OI can also be used for couples with mild male factors.

To understand how OI works, it's important to know what happens during a normal menstrual cycle:

The menstrual cycle and the role of hormones

The menstrual cycle and the role of hormones

LH - luteinizing hormone
FSH - follicle stimulating hormone

Enlarge diagram

The follicular phase lasts 10 to 14 days and starts on the first day of your period (Day 1 of your menstrual cycle). The hypothalamus (a gland in the brain) releases GnRH (gonadotropin-releasing hormone), which tells the pituitary (another gland in the brain) to produce FSH (follicle-stimulating hormone). FSH causes several follicles (egg sacs in your ovaries) to start developing. Eventually, one follicle takes over. Its egg begins to mature, and the follicle releases the female hormone estrogen into the blood. The increase in estrogen levels tells the brain to stop making FSH.

Ovulation starts when estrogen levels become high enough to cause the pituitary to release LH (luteinizing hormone). This is called the LH surge, and it triggers the ovaries to release an egg. A woman ovulates about 14 days before the beginning of her next period.

The luteal phase lasts about 14 days and starts after ovulation. In this phase, the empty follicle (the one that used to contain the egg) starts to produce the female hormone progesterone. Progesterone prepares the uterus lining for a fertilized egg to implant. If the egg is not fertilized, progesterone levels drop, causing the lining of the uterus to shed. This is what causes the bleeding during your period.

Ovulation induction medications mimic the body's natural hormones, and act on different parts of the menstrual cycle to encourage ovulation. Medications that may be used during OI include:

Medications taken by mouth usually start things off, depending on your individual situation, and are easily accessible:

  • Clomiphene citrate (Serophene®, Clomid®) stimulates the production of FSH (which helps the egg mature) and LH (which encourages ovulation). It is most often used for 5 days in a row, typically starting on Day 5 of the menstrual cycle (Day 1 is the first day of your period, the first day of bright red flow). Your physician or fertility specialist will decide the best dose and timing for you.

Typically doctors use an approach like the following when treating fertility issues related to ovulation:

  1. Clomiphene citrate and timed intercourse.
  2. Medications given by injection with or without clomiphene citrate with IUI procedures.
  3. Medications given by injection with or without clomiphene citrate with IVF procedures.

Injectable medications can include the following:

  • FSH (follicle-stimulating hormone)
  • hCG (human chorionic gonadotropin)
  • GnRH (gonadotropin-releasing hormone)

Each fertility journey is unique and it is up to your physician to determine the proper course for you to take.

Medications taken by mouth are usually used when treatment involves timed intercourse cycles or IUI. Many people starting treatment for fertility problems start with medications taken by mouth, which are typically prescribed by their obstetrician/fertility specialist or in some cases a family doctor. If these don't work, your doctor may refer you to a fertility specialist if you aren't already seeing one. Injectable medications can be tried when medications taken by mouth don't yield successful results. Sometimes, fertility specialists recommend for women to try a combination of medications taken by mouth and medications given by injection.

Medications given by injection often come later in the fertility journey and are usually prescribed by fertility specialists. To find a fertility specialist in your area, click here.

If you are receiving OI to help with assisted reproductive technologies, you may also be using other medications.

To learn more about OI and OI medications, speak to your doctor or find a fertility clinic near you.

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