Ovulation induction

What is Ovulation Induction?

Ovulation induction is a method of assisted reproduction which is appropriate for the treatment of fertility problems in women who do not have normal ovulation or have no ovulation at all because of hormonal disorders or because of Polycystic Ovary Syndrome.
 
Medications Used for Ovulation Induction

Your physician will determine the type of medication and dosage you will need. This is based on your age, your AMH level, your antral follicle count, and your underlying diagnosis. 

Clomiphene citrate (Clomid)

• Clomid is a pill that blocks estrogen receptors and stimulates production of more FSH (higher levels of FSH stimulate one or more follicles to develop). Side effects may include headache, hot flashes, bloating and mood swings.
• To minimize the risks of multiple gestation, you will be monitored closely during your cycle; we do not recommend proceeding if you have more than four dominant follicles.
• It is often used as first-line therapy in couples with unexplained infertility.

 
Letrozole (Femara)

• Letrozole is a pill that temporarily reduces estrogen levels (this also stimulates production of more FSH). Side effects may include headache, hot flashes, bloating and mood swings.
• To minimize the risks of multiple gestation, you will be monitored closely during your cycle; we do not recommend proceeding if you have more than four dominant follicles.
• It is often used as first-line therapy in women with polycystic ovarian syndrome.

 
Injectable gonadotropins (Follistim/Gonal F/Menopur)

• These are injectable hormones that contain either FSH alone or both FSH and LH to help promote follicle growth.
• Injectable hormone use has a high rate of twins and triplets, so patients on these medications must be carefully monitored to minimize this risk.
• To minimize the risks of multiple gestation, you will be monitored closely during your cycle; we do not recommend proceeding if you have more than four dominant follicles.

 
hCG (Ovidrel, Novaryl)

• This is an injection that mimics the body’s LH surge, which causes the egg to mature and be released from the follicle. 

Process: Clomid or Letrozole

While not everyone’s ovulation induction process will be the same, the general process one can expect is outlined below.
 
Step 1
Baseline testing is done to confirm that you are not pregnant prior to starting medications. This will be done on Day 2 to Day 5 of full flow of menses, and involves ultrasound and lab work. To schedule testing, inform your nursing team via the MyNM Patient Portal on Day 1 of your full-flow period.
 
Baseline testing is done in the morning in order to get results the same day. These visits are meant to be quick because we realize that most of our patients work. If you have an urgent issue and must speak to a nurse during monitoring, please let the ultrasound tech know. Otherwise, you may leave after your bloodwork and ultrasound are complete. (Note: Please check with your office for scheduling and visit times.)
 
Step 2
If your baseline ultrasound is normal (no large cysts on the ovary) and your blood pregnancy test is negative, you will be instructed via the MyNM Patient Portal to start your medication.
 
Step 3
A mid-cycle ultrasound will be performed on approximately Day 13 of your cycle. The goal is to have one to three follicles that measure 16 mm or greater. Your uterine lining (endometrial thickness) should be greater than 6 mm.
 
Step 4
An hCG injection is given to trigger final egg maturation when the ovaries are ready. This can be easily self-administered on the evening after your monitoring scan. Freedom Pharmacy has an online tutorial that shows how to self-administer Ovidrel. If you have a male partner, you should have intercourse the night of your hCG injection.
 
Step 5
If intrauterine insemination (IUI) is part of your treatment course, you should schedule your IUI on the second morning after the hCG trigger shot. You should also plan to have intercourse the night of your IUI if possible. All partners must have an infectious disease screening prior to IUI, regardless of sex/gender.
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If IUI is not part of your treatment course, then have intercourse the night of your hCG injection and again 24 to 36 hours after your injection.
 
Step 6
A home pregnancy test can be taken 15 days after your hCG injection. If positive, please notify your nursing team through the MyNM Patient Portal. You will be asked to have a blood pregnancy test (bHCG) for confirmation and a second blood test 48 hours later. 

Process: Injectable Gonadotropin 

Here are the steps you can expect if you will be using injectable gonadotropin: 

Step 1 
Baseline testing is done to confirm that you are not pregnant prior to starting medications. This will be done on Day 2 to Day 5 of full flow of menses, and involves ultrasound and lab work. To schedule testing, inform your nursing team via the MyNM Patient Portal on Day 1 of your full-flow period. 

Step 2 
Expect to have an ultrasound and bloodwork done at your visits. Baseline testing and follicle scans are done in the morning in order to get results the same day. These visits are meant to be quick because we realize that many of our patients work.
 
If you have an urgent issue and must speak to a nurse during monitoring, please let the ultrasound tech know. Otherwise, you may leave after your bloodwork and ultrasound are complete. (Note: Scheduling and visit times vary between sites. Please check with your office for details.) 

Step 3 
If your baseline ultrasound is normal (no large cysts on the ovary) and your blood pregnancy test is negative, you will be instructed to start your injections that evening. 

Step 4 
Injectable hormones should be administered every evening as instructed. Follistim, Gonal F and Ovidrel should all be kept refrigerated. You may experience some redness and burning at the injection site. Side effects include mood swings and bloating. 

Step 5 
You will be monitored every few days to ensure that you are developing the appropriate number of follicles. Some women are on injections for 5 days, and others require up to 14 days to produce mature-sized follicles. Each cycle for each patient is different. 

We recommend abstaining from sexual intercourse while on injectable hormones in case you develop too many follicles and we recommend cancellation. This minimizes the risk of becoming pregnant with twins and triplets. 

Step 6 
An hCG injection is taken to trigger final egg maturation when the follicles are of mature size. This can be easily self- administered on the evening after your monitoring scan. You should have intercourse the night of your hCG injection. 

Step 7 
If IUI is part of your treatment course, you should schedule your IUI approximately 36 hours after the hCG trigger shot. You should also plan to have intercourse the night of your IUI if possible. All partners must have an infectious disease screening prior to IUI, regardless of sex/gender. 

Step 8 
If you will not have IUI, then have intercourse the night of your hCG injection and again 24 to 36 hours after your hCG injection. 

Step 9 
A home pregnancy test can be taken 15 days after taking the hCG shot. If positive, please notify your nursing team through the MyNM Patient Portal. You will be asked to have a blood pregnancy test (bHCG) for confirmation and a second blood test 48 hours later. 

We prefer to communicate test results to you via the MyNM Patient Portal, usually later the same day as your bloodwork is done. Please sign up and activate your account if you have not already done so. 

The MyNM Patient Portal also allows you to email your care team at any time. It is used by both physicians and nursing teams during office hours (8 am to 5 pm, Monday through Friday). If you prefer to receive a phone call rather than a message via the MyNM Patient Portal, please notify the nursing team. 

To Request an Appointment

Northwestern Medicine Fertility Center is now conveniently located in four locations: Chicago, Geneva, Highland Park, and Oakbrook Terrace.

Visit our Locations & Appointments page for more information.

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