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Ovulatory Stimulation

Imbalances or deficiencies in hormones from various glands, including the thyroid, pituitary, adrenals or ovaries, can seriously disturb ovulation–the release of the human egg from the ovary and into the reproductive tract–a necessary step for conception. For this reason, many of the treatments that Virtua gynecologists provide for infertility deal with managing hormonal status.

The therapy involves suppressing over-produced hormones or stimulating the production of under-produced hormones by either hormone stimulation or hormone supplementation. Sometimes this noninvasive approach can resolve a woman’s fertility problems.

Virtua fertility specialists know how to select from a series of
hormonal options to achieve ovulation –– and how to
manage and monitor this therapy carefully and responsibly.

Successful Solutions Available

If the team determines that a woman who is seeking to become pregnant is not ovulating sufficiently, it often prescribes the medication clomiphene  as a first line of treatment. This drug causes the pituitary gland to more strongly stimulate the ovaries and their egg development. This most commonly used of ovulatory stimulants is highly effective in enhancing ovulation. About four out of five women who undergo this therapy achieve ovulation with it. And, if treated under careful management by experienced reproductive endocrinologists such as those at Virtua, about half of patients will become pregnant with clomiphene therapy.

If clomiphene therapy fails, the Virtua specialists will often administer either oral or injectable progesterone, adding it during the second half of the woman’s cycle after ovulation, to augment internal progesterone production. Again, this therapy can be successful in up to half of the cases requiring its use.

Additional Carefully Managed Hormonal Options

Patients still requiring additional stimulation often have inadequate gonadotropin production. For these women, the team will typically induce ovulation with gonadatropin injections. Gonadatropins are two hormones naturally released from the pituitary gland that stimulate the ovaries. These hormones are follicle stimulating hormone (FSH) and luteinizing hormone (LH). The gonadatropins are given individually or in combination as a daily injection.

Clomiphene SafetyProfile Clarified
Concerns during the early 1990’s that the use of clomiphene predisposes women to subsequent ovarian cancer have largely been proven unfounded. Both new, prospective studies and review of the statistical methods used in the earlier studies point to the safety of clomiphene.

FSH and LH stimulate the development of eggs in follicles, the small, fluid-filled sacs in the ovaries. The intense egg stimulation achieved with these supplements means increased chance of multi-fetal pregnancies, including triplets, quadruplets and quintuplets. But a skilled reproductive endocrinology service such as that at Virtua can significantly reduce this concern through carefully managing the stimulants with blood testing and through monitoring the status of the ovaries with ultrasound. If the dose of the medication is tailored to the individual patient’s response, the majority of couples will conceive only one or, occasionally, two children.

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