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At the beginning of a menstrual cycle, an egg begins to develop in the ovary. Ovulation is the release of a woman’s egg after approximately two weeks of growth. Anovulation — the lack of normal, regular ovulation — and ovulation disorders are present in up to 20 percent of infertile couples. There are several disorders associated with ovulation dysfunction, with polycystic ovarian syndrome (PCOS) being the most common.
Fertility Drugs as the First Line of Treatment
Women with ovulation disorders are typically given fertility medications as the first line of treatment. While there are a variety of fertility drugs designed to stimulate follicle growth and egg development, all have the same goal: to induce ovulation.
Your doctor will determine which drug, or combination of drugs, best addresses your specific infertility issue. Typically, these are short-term treatments — anywhere from a few days to a few weeks. If you have good quality eggs, and there are no other fertility problems, fertility medications can pave the way towards pregnancy.
Oral Fertility Drugs
One of the most common fertility drugs, clomiphene citrate (sold as Clomid or Serophene), triggers the pituitary gland to release hormones that help ripen a follicle and produce an egg. Clomid is taken as a tablet for five days during your menstrual cycle, requires little or no monitoring with ultrasound or blood tests, and is usually well tolerated. Side effects, including hot flashes, headaches and bloating, occur in less than 10 percent of patients. There is a chance of ovarian hyperstimulation syndrome, in which the ovaries become enlarged. Also, the incidence of twins increases slightly because more than one egg may be released.
Studies show that more than 50 percent of women treated with Clomid ovulate. For those who don’t respond on the first try, the dose is increased during the next cycle, and possibly once more after that.
Injectable Fertility Drugs
If the drug is still ineffective, or the patient can’t tolerate it, a doctor may move onto injectable fertility drugs, called gonadotropins, to spur follicle growth. This therapy, which costs more than Clomid and carries the added cost of ultrasound and blood monitoring, is often tried for six to 12 months. It also brings the risk of ovarian hyperstimulation syndrome and an increased chance of multiple births.
Success rates with injectable medications vary and are influenced by many factors, including egg quality.
When the Thyroid's to Blame
If an underactive thyroid is at the root of an ovulation disorder, a doctor may prescribe a thyroid hormone. For women with PCOS who have abnormal insulin production, a diabetes drug called metformin may be used.
In some cases, a simple change of lifestyle is recommended. Even a small amount of weight reduction and exercise can go a long way toward inducing ovulation naturally.