What Are Basic Fertility Treatment Options?

During ovulation induction, you take oral or injectable medication to increase your chances of ovulating. When ovulation occurs, your ovary releases an egg in the fallopian tube to be fertilized by the sperm during planned intercourse or intrauterine insemination. When ovulation induction is used to increase the numbers of eggs developing (maturing) it is called superovulation.

Clomiphene Citrate (Clomid) or Letrozole (Femara) is a pill taken beginning on day 3 or 5 after a woman begins her cycle and is continued for 5 days. Gonadotropins (e.g. Gonal F, Follistim, Menopur) are injectable medications typically started on day 3 after a woman begins her cycle (cycle day 3) and are taken for 7-10 days.

Clomid works to block estrogen receptors in the hypothalamus and pituitary glands. This action prevents estrogen from interacting with the pituitary gland. After this occurs, your body then naturally begins to increase the hormones called, LH, FSH and Estrogen which are important in the egg maturation and ovulation process. When Clomid is given to males, the hormone levels are monitored at regular intervals.

Femara (generic name is Letrozole) is an oral medication that can be an effective fertility treatment for women with ovulation problems (anovulation), polycystic ovary syndrome (PCOS) or for those with unexplained infertility.

It works by blocking the enzyme aromatase in the ovary which prevents estradiol (estrogen) production. This action suppresses your estrogen levels and triggers your brain and pituitary gland to increase the output of FSH (follicle stimulation hormone) resulting in ovulation induction (OI).

In women who are ovulating, Letrozole can stimulate the development of multiple follicles and eggs to be released often known as controlled ovarian hyperstimulation. This improves your chance of pregnancy as compared to a natural menstrual cycle where only one egg is released.

When Letrozole is used in combination with intrauterine insemination (IUI) your chances of pregnancy may significantly improve. It also can be an effective medication alternative where clomid has not resulted in a pregnancy success or positive outcome.

In a 2014 NIH funded study, researchers found that women treated with letrozole as compared to clomophene were more likely to ovulate as well as increase their chances of having a live birth.

Gonadotropins are hormones naturally produced by the pituitary gland in both men and women. One is known as the follicle-stimulating hormone (FSH) and the other is luteinizing hormone (LH). In women, these stimulate the ovaries to release an egg (oocyte).

You may be prescribed Gonadotropin hormone treatment if the medications Clomid or Letrozole did not result in a pregnancy, or if you have a low egg count as determined by your AMH or antral follicle count (AFC). This is usually given early in the menstrual cycle by injection to stimulate your ovaries to make multiple follicles (cysts where the eggs develop and mature). Your doctor may prescribe these hormones in combination with other fertility medications such as clomiphene citrate (clomid).

Unlike Letrozole that stimulates your brain to make and release follicle-stimulating hormone (FSH), gonadotropins actually contain FSH (e.g. Gonal F, Follistim) or a combination of FSH and LH (e.g. Menopur, Repronex) which stimulate the ovary directly. Patients with PCOS should not undergo ovulation induction with injectable medications due to the high risk of getting 4 or more follicles and the possibility of triplet or higher order multiple pregnancy.

Ovarian Hyperstimulation Syndrome (OHSS) – OHSS is characterized by enlarged ovaries and fluid accumulation in the abdomen after stimulation by gonadotropins and after ovulation occurs.

Multiple Gestation – When using injectable gonadotropins alone or with IUI, up to 30% of pregnancies are associated with multiple implantations (twins or more), which only occur in 1% to 2% of naturally occurring pregnancies.

Ectopic (Tubal) Pregnancy – While ectopic pregnancies occur in 1% to 2% of naturally occurring pregnancies, in gonadotropin cycles the rate is slightly increased.

Adnexal Torsion (Ovarian Twisting) – In less than 2% of gonadotropin cycles the stimulated ovary can twist on itself since the ovary is heavier from more follicles.

Local or Generalized Reactions – Hormone injections may cause local skin irritation.

Gonadotropins and Cancer – Although early studies suggested that the risk of ovarian or other cancers of the female genital tract might be increased when exposed to medications for ovulation induction, current studies have shown no increase in any cancers with the use of fertility medications.