Ovulation and Fertility

See a fertility specialist now
If you are trying to get pregnant and suspect ovulation or infertility problems time is important. Don't wait, see a specialist (reproductive endocrinologist) for a consultation.

For many people one of the first steps in trying to conceive is for the woman to monitor her ovulation cycle using an ovulation calendar, ovulation calculator or ovulation chart. But, if conception has still not occured after about 6 - 12 months a fertility specialist should be consulted.

When a couple decides to investigate why they haven't yet become pregnant, one of the first questions that must be addressed is whether the woman is ovulating adequately for conception to occur.

According to Dr. John Schnorr of the Southeastern Fertility Center, 30 to 40 percent of women are found to be anovulatory upon assessment, that is, not ovulating enough to conceive without assistance. These women may sometimes ovulate, but not regularly enough to be able to predict fertility and plan conception. Women in this situation will be introduced to the concept of what is called ovulation stimulation or induction.

Upping the odds

"In its simplest form, the goal of ovulation induction is to help these women ovulate monthly," explains Schnorr.

Ovulation stimulation may also be recommended for those patients who are ovulating regularly, but who are coping with some forms of male factor infertility or unexplained causes of infertility. "For those women," says Schnorr, "we can do what we call 'superovulation' -- give them medications for the sole intention of creating more than one egg per cycle -- to increase their chances of getting pregnant."

When considering the miracle of conception -- one egg meeting one sperm to create an embryo -- superovulation via fertility medications is simply a way to boost the odds. More eggs, more chances to conceive.

Whenever fertility medication is used in conjunction with in vitro fertilization (IVF), the goal is to help the woman's body create 10 or more eggs. Again, it's a way to maximize chances for success. Dr. Schnorr explains, "This allows us to generate a higher number of embryos. Then, we can evaluate and only transfer back the embryos that will give the woman a good chance at pregnancy."

Generally speaking, out of 10 eggs, five to seven will fertilize to embryo stage, and then of those, about half will have the best qualities for pregnancy.

Comparing the options

Ovulation stimulation is done through administering of special medications, often referred to as fertility drugs, to the woman. Medications range from relatively inexpensive orals (tablets of the drug clomiphene citrate) to more costly injectables. Some of the most widely used injectable medications at the time of this writing are follitropin alfa or beta, and urofollitropin.

Costs of ovulation stimulation vary greatly from patient to patient, since the level of assistance needed is so dependent on many individual factors. Generally, the costs for fertility drugs per treatment cycle can run from $50 to $2000.

Cost isn't the only difference between clomiphene and injectable drugs. The most important difference lies in how the drugs work to promote ovulation. Clomiphene is what's called an 'antiestrogen' which in effect tricks the body into ovulating eggs. The injectable medications are made up of naturally occurring hormones given in excess which results in not only more eggs, but eggs of higher quality than the woman may ovulate without such assistance.

Clomiphene is often the first line of treatment for many women, but it is not generally used in IVF, and can sometimes actually lower chances at conception through its antiestrogen action. Statistics point out that most women who respond well to clomiphene by ovulating do so within the first cycle of treatment.

A typical IVF cycle and some artificial insemination cycles use medications that are injected subcutaneously (with a small needle just under the skin) at home by the patient (or her partner), accompanied by stringent monitoring by the clinic staff. Monitoring includes ultrasound and checking of hormone levels by blood draw approximately every three days. Such monitoring is important because there are some risks involved for the woman, notably ovarian hyperstimulation, a situation that can result in nausea and abdominal distention and which can be remedied quickly upon observation.

Another risk of ovulation stimulating medication use is multiple pregnancy (ranging from 20 - 40% depending on the drug used and the number of eggs produced.)

Expanding the choices

Pharmaceutical companies are always exploring ways to make the use of fertility medications more convenient, to ease the disruption of everyday activities that can accompany fertility treatment cycles. Recently, one manufacturer received approval for a pre-filled syringe, which removes the need for mixing medications by the patient at home.

Also, investigations and development are ongoing to find more efficient drugs and protocol. Dr. Schnorr says that the future for ovulation induction includes the use of drugs classified as aromatase inhibitors, new oral medications that give higher pregnancy rates than clomiphene citrate at about the same cost. Currently more widely used for treating breast cancer, aromatase inhibitor for fertility purposes is still experimental.

Ovulation assistance in general is an area of reproductive medicine that is well established and rigorously studied. The well-managed use of ovulation induction to help women conceive is partly responsible for the rapid growth of reproductive technology's success in recent decades.

Links:

Dr. John Schnorr

Southeastern Fertility Center

See a fertility specialist now
If you are trying to get pregnant and suspect ovulation or infertility problems time is important. Don't wait, see a specialist (reproductive endocrinologist) for a consultation.