Fertility-enhancing medications can be given to women who infrequently ovulate or who do not ovulate at all, such as those with Polycystic Ovary Syndrome (PCOS), and they are also given to subfertile women who have been ovulating monthly but have not achieved a successful pregnancy.  These medications help grow follicles (follicles are fluid collections within the ovary that contain the eggs) and help to optimize hormone levels.

Clomiphene citrate (Clomid):

FDA-approved for ovulation induction in 1967, this oral medication is the most frequently prescribed medication used for ovulation induction.  Clomid comes in a 50mg pill and can be started on either cycle day 2, 3, 4 or 5 and is typically given for five days.  Its benefits may include follicular development, endometrial thickening, and increased progesterone levels in the luteal phase.  In some women, clomid can have an antiestrogenic effect at the level of the endometrium and/or the cervical mucus.  Women who are taking Clomid have the option of ultrasound monitoring and/or checking ovulation predictor kits.

Letrozole (Femara):

FDA-approved for breast cancer therapy and used off-label for ovulation induction.  An abstract in 2005, with several study design limitations and 150 babies studied, raised concern about birth defects; however, a well-designed study that was published, with 911 babies studied, did not show an increased risk over the general population risk for birth defects.  Femara’s benefits are similar to those of Clomid and Femara does not seem to have antiestrogenic effects on the endometrium and cervical mucus.  Women who are taking Femara have the option of ultrasound monitoring and/or checking ovulation predictor kits.

Gonadotropins — FSH (Follicle-Stimulating Hormone) or FSH/LH (Follicle-Stimulating Hormone/Leutinizing Hormone):

Gonadotropins are administered subcutaneously (into the tissue under the skin) in the abdominal area.  The medication is self-administered daily for approximately 7-10 days in most patients.  Fertility protocols with gonadotropins require ultrasound monitoring and estradiol level checks in order to assess ovarian response to the medication since some women may under- or over-respond to the medication.

FSH and/or FSH/LH also are given to women who undergo IVF in order to grow multiple follicles in preparation for egg retrieval.  Other medications, depending on the IVF medication protocol, are given in order to prevent an LH surge while the follicles are grown.

Combination Protocol:

This type of protocol combines a 5-day course of oral medication (Clomid or Femara) with a short course of gonadotropins at a lower daily dose.  This is a reasonable alternative for couples who have not achieved a successful pregnancy with oral medication alone and also is at a lower cost than a gonadotropin cycle.  Combination protocols require ultrasound monitoring and estradiol level checks in order to assess ovarian response to the medication since some women may under- or over-respond to the medication.

hCG (human Chorionic Gonadotropin):

Once the follicle has grown to a certain size where the egg within it is able to be fertilized after it ovulates, hCG can be given in order to release the egg from the follicle.  hCG is structurally similar to LH and the injection functions as an LH “surge”.  The egg will release in approximately 36 hours after this one-time injection.  hCG can be given either subcutaneously or intramuscularly.

hCG can be given to release a mature egg(s) during ovulation induction cycles (clomid, femara, gonadotropin, or combination protocols).  hCG also is given to women who undergo IVF in order to prepare the eggs for fertilization; the egg retrieval is time-sensitive and must be performed within 35-36 hours after the hCG injection.