An essential part of successful fertility is timely release of an egg called ovulation. One of the most common causes of infertility is failure for a women to ovulate. There are many causes for ovulation disorders.
Ovulation induction therapy often requires medications to prompt development and release of an egg in a timely way to become pregnant. Our physicians at Michigan Reproductive Medicine are experts at ovulation induction therapy. With medications matched to your specific cause of ovulation disorder, there is excellent hope that ovulation induction therapy will be the key to success in having a child and building your family.
We hope you find this review about ovulation disorders and ovulation induction therapy helpful in preparation for meeting with one of our MRM fertility specialists.
Types of Ovulation Disorders
The most common infertility factor for women is an ovulatory disorder. Ovulatory disorders can be classified by their underlying cause.
Class I Ovulation Disorders (Abnormally low FSH and LH results in not turning on the ovary to ovulate)
Class I ovulatory disorders involve women with abnormally low levels of the essential fertility hormones named follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland that are needed to grow a follicle and release an egg. These women will respond well to ovulation induction therapy using the injectable fertility medications that contain FSH hormone. Replenishing the missing FSH hormone directs the otherwise normal ovary to release an egg. The prognosis for successfully having a baby is excellent.
Class II Ovulation Disorders (Polycystic Ovary Syndrome)
Class II ovulation disorders are experienced by women who have normal levels of pituitary hormones and estrogen, but fail to ovulate.
This category includes women with polycystic ovary syndrome (PCOS). PCOS is a genetically based metabolism disorder, particularly of sugar metabolism that also happens to impair egg follicle and egg development as well as ovulation. A low carbohydrate, high protein diet, metformin and ovulation induction medications can lead to good success in having children. These patients are candidates for ovulation induction therapy with oral medications such as Letrozole (Femara®), clomiphene citrate (Clomid®) and possibly in combination with gonadotropins containing FSH such as Gonal-F®, Follistim®, Bravelle® and Menopur® . hCG (Ovidrel®) or Lupron® can be used to either mimic the LH surge (hCG) or trigger the LH surge (Lupron®).
IVF therapy may need to be considered when patients:
- Do not conceive after three ovulatory cycles.
- Do not ovulate on any of these medications.
- Over-respond with excessive number of lead follicles (3 or more) as is a common risk with PCOS.
Remember, releasing one follicle is infinitely greater than no egg. Your MRM physician is very cautious to avoid multiple gestations. Our MRM physicians often caution that everyone likes a 2-for-1 sale, but that is not a good deal when it comes to becoming pregnant with two or more babies expected to deliver at one time!
Class III Ovulatory Disorders (Diminished Ovarian Reserve)
Class III disorders include women with abnormally high levels of the essential fertility hormones named follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. FSH and LH output is abnormally high trying to compensate for declining function and fertility potential of her ovaries and the eggs within them.
This category includes older women in perimenopause and women with premature ovarian failure (less than 40 years of age) that may be related to genetic abnormalities of their X chromosome, past surgery involving at least one ovary and advanced stages of endometriosis. These patients have the poorest prognosis for having a healthy baby with use of their own eggs.
More aggressive ovulation induction treatment may be considered with IVF therapy using a variety of stategies: aggressive high dose FSH to recruit eggs or natural cycle IVF and minimal stimulation IVF protocols (Mini-IVF). There may be a need to consider use of another woman’s eggs with donor egg bank IVF therapy selecting donor eggs from our Michigan Egg Bank. This alternative results in much higher pregnancy rates.
Class IV Ovulatory Disorders
Class IV disorders involve women with high levels of prolactin (the milk secretion hormone) and or low thyroid hormone levels (hypothyroidism). This results in low FSH hormone levels from the pituitary gland in the brain. Ovary function is turned off with failure to ovulate or even have menstruation. Ovulation induction occurs in response to oral medications (cabergoline) that lower prolactin secretion or thyroid hormone replacement with levothyroxine (Synthroid®). Ovulation resumes and fertility becomes normal.
How Do We Treat Ovulation Disorders?
Cycle Monitoring and Stimulation
An essential part of ovulation induction therapy is the monitoring and stimulation of the ovulation cycle. This is accompanied by close monitoring with blood tests and ultrasound. Blood hormone levels and the size of the ovarian follicles are used to track response to medications and to help your MRM physician predict when ovulation is most likely to occur. Ovulation induction therapy is typically accomplished with an oral medication such as Clomid®, Femara® or with injectable gonadotropins. In specific situations, your MRM physician may recommend progesterone supplemental medications in the second half of a cycle to ensure that the uterus will be properly prepared for implantation of a fertilized egg.
How Do We Verify the Ovulation Successfully Occurred?
Ultrasound Tracking of Ovulation
Ultrasound testing is a highly reliable and safe method of tracking ovulation induction. A vaginal ultrasound is performed at specific stages of an ovulation induction cycle and will give an accurate count and measurement of follicles and eggs as they are developing in the ovaries. This allows for very accurate timing for natural intercourse, artificial insemination, egg retrieval intended for the IVF procedure, to ensure the highest rate of success. The ultrasound procedure is very safe and creates virtually no discomfort. It involves the insertion of a small transducer into the vagina. Both ultrasound and endocrine test monitoring are also offered to confirm the intention of treatment— ovulation induction successfully occurred.
Measuring Hormone Blood Levels
Hormones produced by the brain that direct the ovaries to function normally are follicle stimulating hormone (FSH) and luteinizing hormone (LH). Hormones produced by the ovary that indicate the function of the ovary include estradiol (E2) and progesterone (P4). A hormone that can assess the long term egg quantity in reserve is anti-mullerian hormone (AMH). These hormone tests assist in ovulation induction therapy. They help your physician determine which type and dose of fertility medication may provide the best ovary response and outcome.
Please make and appointment with one of MRM’s fertility expert physicians to learn more about ovulation induction and to begin building your family using the best fertility treatment options available.