Ovulation is the release of a mature egg from its developing follicle in the outer layer of the ovary. This usually occurs approximately 14 days before the next menstrual period (the 14th day of a 28-day cycle).
About 25% of women experiencing infertility have problems with ovulation. The issue may lie in an inability to produce fully mature eggs or failure to release an egg at all (called anovulation).
Follicle Growth and Ovulation
In a normal menstrual cycle, a tiny pea-size bubble called a follicle forms on the ovary containing an egg. If the follicle is measured the day before ovulation, it is about 20mm in diameter (about 1 inch) and it will produce a lot of estrogen (estradiol specifically).
We perform ultrasounds to monitor for size and blood tests to monitor hormone levels 2-3 times per week during every treatment cycle in order to determine just the right moment to either have intercourse at home (Relations) or come into the office for Intrauterine Insemination (IUI).
Fertility Drugs that Induce Ovulation
Some women may need the assistance of a hormonal medication called Clomid to help recruit a follicle. First, clomiphene citrate is taken by mouth for typically 5 days to help release the follicle-stimulating hormones FSH and LH. Both of these hormones stimulate the ovaries to produce eggs and the hormones estradiol (E2) and progesterone( P4). We will monitor the development of your eggs with blood tests, and intravaginal ultrasounds to determine when the egg is mature.
After identifying an appropriate size follicle our patients trigger ovulation with an injectable medication such as Ovidrel. Once the egg is ovulated, we will instruct our patients to have intercourse during a certain period (Relations) or to visit our office for intrauterine insemination (IUI).
Fertility medications may be used to correct other fertility problems such as improving the lining of the uterus (endometrium) in addition to inducing ovulation.
In certain circumstances where the recruitment of several eggs is ideal, fertility drugs may be used to stimulate the development of multiple eggs. These treatment cycles include In Vitro Fertilization (IVF), Egg Freezing and Egg Donation.