Hormonal Treatment for Infertility

1. Ovulation induction with clomiphene (or letrozole as an alternative):

• What is clomiphene?

It is a weak estrogen-like hormone has an effect on hypothalamus and the ovary.
It is to increase the levels of follicle-stimulating hormone and another hormone called luteinizing hormone that is important for ovulation.

• Treatment dosing:

It starts on the 3 to 5 day of the menstrual cycle, one pill a day for 5 days.

If ovulation does not happen during the first month, the dose is increased by 50 mg each month until ovulation occurs or 2.5 mg of letrozole.

• Advantages:

– Not expensive.
– No need for ultrasound or blood tests to check on hormones.
– Low chance of side effects.

• Risks or side effects:

– Ovaries get enlarged resulting in abdomen pain
– Slight chance of multiple pregnancy
– Hot flashes and mood swings
– Headache
– Breast tenderness
– Nausea and vomiting
– Vision problems such as blurring

2. Infertility treatment with gonadotropins:

• Gonadotropins are two hormones:

– luteinizing hormone (LH)
– follicle stimulating hormone (FSH)

It is given as an injection to stimulate the ovaries to produce follicles that contain eggs. It is advised when treatment with clomiphene was not successful.

• Who should consider this treatment:

– When not ovulating at all or ovulating irregularly.
– Women who ovulate normally but to improve the chances of becoming pregnant (by IUI, IVF or intercourse).
– Treatment with Clomiphene was not helpful.

• Preparation:

In day 3 to 5 of the menstrual cycle, blood test will be done to check hormones level, and pelvic ultrasound to make sure there is no cysts.

The timing and the amount of the treatment will be given based on the results of these tests.

• Treatment dosing:

It differs from patient to another.
It is preferable to start with small doses to avoid the risk of growing many follicles.

Usually the injection is given once per day, under the skin.

After few days, blood test and ultrasound will be done to measure the follicles growth, Based on that, the does might be increased or decreased.

• Side effects:

Not likely to happen but can include:
– Abdominal discomfort due to ovaries increase in size.
– Nausea and vomiting.
– Conceiving a multiple pregnancy.