Ovulation stimulation with oral medication
As a first line of active medical treatment, oral stimulation medication is widely used. This is especially helpful for women with irregular periods, which is suggestive of a problem of ovulation, or egg release. This level of treatment is also widely used in many women with normal cycles, who are seeking a simple, easy to use, inexpensive treatment with a low side effect profile. These medications include Clomiphene Citrate (Clomid), Letrozole (Femara), and Tamoxifen. These medications act to enhance a woman’s’ ovulation, and yield a 5-10 % per cycle pregnancy rate when combined with timed intercourse or intrauterine insemination (IUI). Risks of ovarian hyper-stimulation (over-stimulation) and multiple gestations (twins, triplets etc,) are low. Many couples opt for 3-4 cycles at this level before progressing to more advanced treatment. Individual circumstances or choice, however, may warrant a more intense treatment approach.
Ovarian stimulation with Injectable medication and Intrauterine Insemination
For those individuals who have not achieved success with oral medication, or for those whose individual needs are appropriate for going straight to this level, injectible medication in combination with Intrauterine Insemination (IUI) can be a a very effective treatment plan. This treatment involves a regimen of daily home self-administered hormonal injections to directly stimulate extra ovarian follicles (egg sacs). Ultrasound and blood work are performed at periodic time intervals, generally for 8-12 days of stimulation to monitor the safety and effectivess of this stimulation. At the end of the stimulation, after it is determined that a sufficient number of ovarian follicles have been stimulated, a final “trigger shot” of the hormone HCG (Ovidrel, Novarel, and Profasi) will be administered. This will cause ovulation to occur in an exact timed fashion. Washed sperm, obtained from husband, partner, or donor, is then injected into the uterus approximately 35 hours after the HCG injection. The intrauterine insemination of washed sperm facilitates a better sample of sperm placed closer to the desired target, the fallopian tubes where fertilization will take place. Pregnancy rates range generally from 20-30% with this level of treatment, though individual results may vary. Higher rates of multiple gestations and excessive ovarian stimulation can occur with this level, though with close observation with ultrasound and blood work during stimulation these risks can be minimized. A blood pregnancy test is performed two weeks after the IUI to test for the success of this treatment regimen.