This is intended as a guide to our preferred method for ovulation induction with oral medications.
When ovulation is delayed or not achieved, there are several options for inducing ovulation. Injectable medications are considered more potent and, in most cases, more successful, but are expensive and subject to greater complications. Injectable protocols require greater supervision and are usually managed by reproductive endocrinologists.
At Virginia Center for Women, we use 2 oral medications for ovulation induction; Clomid and Femara. Both are used early in the cycle to “jump start” the ovaries and promote follicular development. Though more simple to use than injectables, these medications can produce side effects and, in rare circumstances, cause significant medical complications. Most women tolerate these medicines without significant side effects. Some might experience breast tenderness, hot flashes, nausea, mood swings, bloating, pelvic pain, weight gain and/or acne. Possible complications include an increased risk of multiple pregnancies (twins, triplets, etc) and ovarian hyperstimulation (OH). Though OH is uncommon with these medications, we recommend you immediately report any significant pelvic pain or increase in abdominal size.
Clomid is used in doses of 50, 100 or 150 milligrams. Femara doses are 2.5 and 5 milligrams. We will gradually increase medication doses to achieve ovulation, while hoping to avoid overstimulation and OH. Both medications are used daily for 5 days. At the end of each cycle, we will review our success at achieving ovulation and alter the type of medication or dosage as needed.
After achieving ovulation we ordinarily maintain the dosing for 3 cycles. If pregnancy is not achieved in those 3 cycles, we may consider other measures such as intrauterine insemination (IUI). It is uncommon to continue these medications for 6 cycles if pregnancy is not achieved.