Medications for Inducing Ovulation
In the event that a woman does not ovulate spontaneously, ovulation can often be medically induced. Here at the Southeastern Center for Fertility and Reproductive Surgery, we utilize several medications to induce ovulation.
The most common ovulation induction medications are:
- Clomiphene citrate (Clomid)
- Letrozole (Femara)
- Tamoxifen (Nolvadex, Soltamox)
- hMG (Lepori, Menopur, Repronex)
- FSH (Bravelle, Puregon)
- rFSH (Follistim, Gonal F)
- hCG (Pregnyl, Novarel, Profasi, Profasi HP, Chorex)
- rhCG (Ovidrel)
Empiric therapy, usually including intrauterine insemination (IUI), with Clomid offers pregnancy rates of 5-9 percent per cycle, whereas empiric therapy with HMG offers pregnancy rates of 15-20 percent per cycle.
In cases of Clomid resistance, we utilize Femara and Tamoxifen, which are two other medications used for ovulation induction. These medications can be used alone in varying doses or in combination to induce ovulation in those who are not ovulating spontaneously or who do not respond to Clomid.
Low doses of Dexamethasone can be used for patients who are resistant to Clomid and have an elevated Dehydroepiandrosterone sulfate (DHEAS) laboratory value.
For insulin resistant patients, we implement Metformin to improve insulin sensitivity. A significant number (about 20%) of these anovulatory women ovulate and may achieve pregnancy with this therapy alone. Metformin is less effective in women who are not insulin resistant, and is often reserved for those with increased body mass index (BMI). Long acting forms of Metformin are given to reduce the significant gastrointestinal intolerance of standard Metformin therapy. If patients do not tolerate Metformin therapy, they are often switched to non-prescription alternative therapies (see below).
Alternative therapies for ovulation induction
Alternative therapies for the management of insulin resistance (highly prevalent in polycystic ovarian syndrome [PCOS] patients) are beneficial for those individuals who do not tolerate or respond to traditional therapies such as Metformin. In addition, alternative therapies may be used in combination with traditional medical therapies in patients who have an inadequate response to traditional treatment. Equally important, alternative therapies appeal to those individuals who prefer a more natural, holistic form of management. Currently, the Southeastern Center for Fertility and Reproductive Surgery uses the following three supplements to treat and manage PCOS patients: D-Chiro-Inositol, N-Acetyl-Cysteine, and Chromium Picolinate.
D-Chiro-Inositol is a natural insulin-sensitizing supplement. A deficiency in DCI may contribute to insulin resistance. Studies reveal that women with PCOS have a decreased circulating concentration of DCI and that the administration of DCI to women with PCOS decreases the insulin response to orally administered glucose. In previous studies, subjects experienced no side effects related to DCI. In addition, DCI may improve ovulatory function, hyperandrogenism, blood pressure, and triglycerides.
N-Acetyl-Cysteine is a safe and well-tolerated supplement which has been used to treat various medical conditions. It is a precursor of the amino acid L-cysteine and has been shown to have an influence on insulin secretion in pancreatic cells, as well as the regulation of the insulin receptor in human erythrocytes. In addition, it is a powerful antioxidant and a potential therapeutic agent in the treatment of cancer, and other diseases characterized by the generation of free oxygen radicals. It has been shown that NAC is able to improve insulin secretion in response to glucose. NAC administration is well tolerated with no adverse effects.
Chromium Picolinate is an over-the-counter dietary product that improves insulin sensitivity and improves the rate of glucose disposal in patients with PCOS. There are no adverse side effects associated with this supplement. Chromium picolinate is an extremely safe and highly tolerable trace mineral that is present in the normal diet. Chromium picolinate is useful as an insulin sensitizer and improves glucose tolerance in women with PCOS.
Overall, there are specific advantages and disadvantages to each type of treatment. Please call our office or make an appointment to discuss further questions you may have.