Ovulation induction (OI) is a therapy involving stimulation of the ovaries to produce multiple eggs. For women in whom ovulation appears to be the only issue, this type of therapy may be sufficient to achieve pregnancy.
Clomiphene citrate (Clomid) and Letrozole (Femara) are oral medications which are commonly prescribed for this therapy due to their effectiveness, low cost and relative safety. More potent injected medications, which require additional monitoring of your body's response to these drugs, are another option for treatment. These medications may also be used to control the timing of ovulation, or in conjunction with intrauterine insemination or in vitro fertilization.
Potential risks associated with use of these medications include an increased chance for multiple births and the development of ovarian cysts.
Intrauterine insemination (IUI) is a simple procedure in which a slender tube is used to place sperm into the uterus around the time of ovulation. It is often recommended for patients suffering from low sperm count, low motility, sperm/mucus incompatibility or other medical conditions.
Inseminations are performed after monitoring ovulation patterns with ovulation predictor kits. Intrauterine insemination may also be used in conjunction with ovulation induction. Frequently, couples find that it may take several cycles with inseminations for conception to occur.
Most couples seeking fertility treatment want their plan to be as simple as possible.
For decades now the typical entry level of fertility treatment for a variety of underlying conditions has been ovulation induction (OI) with intrauterine insemination (IUI). The goal of these combined treatments is simple; cautiously enhance the number of fertile eggs a woman produces and then optimally time the exposure of these eggs to healthy sperm. Thus, OI is the use of medication (Example: clomiphene citrate, letrozole)—under carefully monitored conditions—to boost the ability of a woman’s ovaries to produce more than one egg per reproductive cycle. The culmination of the ovulation induction is typically followed by the use of medication to trigger egg release and then trailed by an IUI (the processing of a sperm specimen by laboratory technicians to optimize the sperm quality and the placement of the specimen by a healthcare provider into the woman’s uterus).
OI/IUI can be a treatment option to consider if any of the following exist:
OI/IUI may NOT be a great option if any of the following exist:
In summary, for people that are trying to decide how best to initiate their fertility treatment, there are options. OI/IUI is appealing because it is less costly and considered more natural. However, it also has a lower success rate and a higher risk of multiple births.
One advantage of IVF that is worth considering is that it not only provides the highest pregnancy rate but also the possibility of preserving extra embryos for future attempts. Another advantage to consider with IVF is that it can provide additional information regarding egg and sperm quality that cannot be measured with any other test available. With so many options, we hope you feel encouraged and more prepared to discuss your treatment options with your fertility specialist.
The success rates of OI/IUI vary considerably depending primarily upon the underlying cause(s) of infertility and patient’s age. They can range from <1% -11% per month. For women who have difficulty ovulating on their own, success rates can be as high as 20% per month.
Clomid/clomiphene citrate) and Femara/letrozole are oral tablets taken near the beginning of a woman’s menstrual cycle. They block receptors at the brain which then increase the production of estrogen within the ovaries. However, Letrozole’s lower risk of multiples have made it a preferred choice amongst most fertility doctors. Your physician will determine which medication is best for you.
Patients who are using OI because they do not ovulate on their own and have a male partner with a normal semen analysis, may consider using OI alone without the IUI. If you have unexplained infertility, using OI alone without combining with an IUI does not significantly improve your chance of fertility. Individual circumstances vary and we recommend that you discuss these options with your physician.
IUI success rates are strongly associated with normal results from a semen analysis. Rates drop as sperm counts, motility percentage, and morphology decrease. Pregnancy rates exponentially increase when the total motile count increases from 1 to 10 million. If the total motile count at the time of insemination (after processing) is less than 10 million, chances for pregnancy are much lower and IUI may not be the best option.
Advancing female age has a significant negative impact on fertility, regardless of the method used to get pregnant. Women who are <35 years old can expect up to an 11% chance of pregnancy using the OI/IUI method. Each year after the age of 35 there is a significant drop in success rates. These patients will find that IVF may be a more effective treatment.
The severity of endometriosis is thought to have an impact on the success rates of OI/IUI. In general, females with endometriosis have lower success rates with IUI as compared to women with unexplained infertility. Talk to your physician about your endometriosis and whether OI/IUI is a good choice for you.
After 3 cycles, the success rate for each IUI is significantly lower each cycle. At this point, it is important to consider the cost and benefits of continuing with this form of treatment instead of moving to different (more effective) treatments. If the IUI is going to work, it will be within the first few cycles according to research.