I have a pragmatic approach, and always like to start with the least invasive techniques. For women with irregular periods, occasional periods or no periods, I will usually recommend medication to induce normal follicle development and regular ovulation, with the goal of conceiving naturally.
Depending on your situation, I may also suggest this to you if you have regular menstrual cycles but unexplained infertility.
There are various methods of Ovulation Induction.
The most commonly used medicine for Ovulation Induction is clomiphene citrate. It blocks oestrogen receptors, tricking the brain into producing increased amounts of follicle stimulating hormone (FSH). Usually this causes one or more mature follicles to develop, and consequent ovulation. It is common for women who have this treatment to experience temporary hot flushes, because their oestrogen receptors have been blocked.
Another common method of Ovulation Induction involves injections of FSH, which work directly on the ovaries to develop a follicle or (follicles).
Both of these methods, especially FSH injections, carry the risk of multiple follicles developing. If you are having one of these treatments, I will perform ultrasounds to check the number and growth of the follicles, and I will discuss any risks with you.
After the follicle has developed I may also use another injection of synthetic human chorionic gonadotropin (hCG) to trigger the release of the egg from the follicle. I will guide you about when the best time to have sex will be.
Ovulation Induction may be used in conjunction with timed intercourse or intrauterine insemination (IUI), which introduces the sperm into the uterus at the optimal moment.
What causes ovulation disorders?
Often the problem behind irregular or absent ovulation is hormonal, such as polycystic ovarian syndrome. It may also involve a signalling problem between the brain and the ovaries, which occurs often in women who exercise at a very high level, women who are underweight, and women who do shift work, like flight attendants.
Other less common and more serious causes are premature menopause or premature ovarian failure with damage to eggs and follicles. These conditions cannot usually be helped by ovulation induction, so I will discuss other options with you.