Medications to stimulate ovulation may be prescribed for women who do not ovulate normally, who have unexplained infertility, or as an adjunct to other fertility treatments, such as intrauterine insemination or IVF/IVC. There are two types of ovarian stimulants, oral and injectable. If you are recommended to take one or more of these medications, we will discuss the risks, benefits, necessary monitoring, and costs with you in detail.
Oral ovarian stimulants include clomiphene citrate and letrozole. Both of these medications send a signal to your brain that your estrogen levels are “low.” In turn, the pituitary gland near your brain begins to produce more hormones that cause your ovaries to develop and mature eggs. We preferentially prescribe letrozole rather than clomiphene citrate because letrozole has very few side effects.
Injectable ovarian stimulants include such brands as Gonal F, Follistim, and Menopur. These medications are given subcutaneously (in the fatty tissue) of the abdomen, outer thigh, or the back of the arm. Don’t worry, we’ll be happy to show you or your husband/partner exactly how to prepare and administer the injections. These medications work differently from the oral ovarian stimulants. They actually are the hormones that signal your ovaries to grow and mature eggs. Gonal F and Follistim are similar and contain follicle stimulating hormone (FSH), while Menopur contains both FSH and luteinizing hormone (LH). If you are prescribed these medications, you will require careful monitoring to safely evaluate your response.
Human chorionic gonadotropin (hCG), sometimes called a trigger shot, can be generic, or branded as Pregnyl, Novarel, and Ovidrel. All of these may be administered subcutaneously (in the fatty tissue of the abdomen, outer thigh or the back of the arm). This medication acts similar to your body’s LH to cause the final maturation of the egg(s) and ovulation. Your provider or nurse will let you know an exact time to take this medication, as the timing is of utmost importance when planning inseminations or IVF/IVC.
It really is all about timing. We will help you to understand when the right time is to have intercourse to maximize your chance for pregnancy. This timing may be found by using ovulation prediction tests that are available at your local pharmacy, Target, and Walmart. We recommend Clear Blue Digital Ovulation Test. Simply test your urine each day between 11 am and 2 pm, NOT first thing in the morning. The test will show a smiley face the day before you ovulate. If you are prescribed an hCG trigger shot, you will not need to test for ovulation. Instead, have intercourse the day of your trigger shot and the next two days.
Intrauterine Insemination (IUI)
Intrauterine insemination involves the placement of washed sperm directly into the uterine cavity. An IUI can be performed with the husband’s/partner’s or donor sperm. After collection into a specially tested container, the semen sample must rest for at least 30 minutes. Your husband/partner can collect at home and bring the sample in as long as we receive it within about four hours after collection. Processing (or washing) the sample takes about 45 minutes. A semen analysis is performed before and after preparation. The insemination itself is relatively simple, and it feels similar to a Pap smear. A speculum is inserted. A tiny catheter is passed through the opening of the cervix into the uterine cavity. The sample is then deposited with a syringe--we’re happy to let your husband/partner do this part.
For some cases of male factor infertility or for patients without a male partner, the use of donor sperm may be the recommended treatment option. At IFS, we exclusively use commercial donor sperm banks. These banks have carefully and appropriately screened donors in accordance with FDA regulations and provide a wide range of donor options. Although the donors are considered to be anonymous, you will be able to choose from a wide range of information about each donor, from basic physical and personal characteristics, to photos and videos, to release of contact information to your child(ren) at a later date. It may be or become possible for the identity of your donor to be made known in the future. We’ll be happy to give a list of donor sperm bank options based on our experiences with the various banks.
If any abnormalities are found with ultrasound or on your pelvic examination, you may be advised to undergo surgical treatment. Most of our patients do NOT require surgery. Examples of surgical treatment include treatment of endometriosis, removal of uterine fibroids, removal of uterine polyps or septum, and evaluation and treatment of other abnormal findings from your examination.
In vitro Fertilization (IVF) / Intravaginal Culture (IVC)
In vitro fertilization (IVF) has the highest success rates of nearly any treatment for infertility. However, the process of undergoing IVF has traditionally required high doses of expensive fertility medications, frequent monitoring, and embryology laboratory costs. We are excited to offer a much more affordable option, through combining in vitro fertilization with intravaginal culture using the INVOcell™ intravaginal embryo culture device.
Similar to standard IVF, the IVC process starts by stimulating your ovaries to produce follicles, retrieving eggs from the ovaries, and injecting the eggs with sperm. We then place the injected eggs into the INVOcell device and then place the INVOcell™ into your vagina to allow the embryos to develop. Three to 5 days later, we will transfer the best embryo(s) to your uterus. Any high-quality embryos in excess of the ones transferred may be cryopreserved (frozen) for future use. The difference between our IVF/IVC program and conventional IVF programs is our use of a more gentle ovarian stimulation that requires fewer monitoring visits and the use of INVOcell™.