Ovulation induction is a relatively simple method of assisted reproduction applied when the cause of infertility is located on the woman’s disability to release ova every month (despite the existence of ova in her ovaries). Typical examples of women that may benefit from the method are those suffering from polycystic ovarian syndrome.

Clomiphehe citrate is the most frequently used first-choice drug to induct ovulation; it acts in a quite complicated pattern having as final result a mild ovarian stimulation. This substance is administered orally by form of pills which the woman takes for 5 subsequent days at the beginning of her cycle (usually from the 2nd or 3rd day to the 6th or 7th day of cycle). Clomiphene citrate comes in 50mg tablets. The medication starts with low doses of clomiphene. A few days after the administration of the last pill the woman undergoes serial ultrasonographic scans for the monitoring of follicle(s) growth in her ovaries and for the evaluation of endometrial thickness. When the follicles have achieved a satisfactory size, the day of expected ovulation may either be predicted by detecting an acute rise in blood LH levels that occurs some hours earlier, or be assured through administration of human chorionic gonadotropin which induces final follicle maturation and ovulation. The couple is then advised to have sexual intercourse during the predicted ovulation day. In case that the ovaries do not respond to the initial clomiphene dose, this dose is gradually increased during the subsequent cycles up to a highest 200-250mg daily dose. In the opposite case of an excessive ovarian response after a specific clomiphene dose, sexual intercourse during the fertile days is discouraged to avoid a multiple pregnancy, and the dose is reduced during the next cycle. Clomiphene does not cause any serious side effects; the most commonly reported are temporary disorders of vision, hot flashes, nausea, bloating in the abdomen, and headaches. In the presence of any of the above side effects the woman should contact her attendant physician.

Another way to stimulate ovaries in order to induce ovulation is the administration of fertility drugs called gonadotropins which are the same substances secreted from a woman’s own pituitary gland, act on her follicles fostering their growth and maturation, and actually regulate the woman’s cycle ensuring the release of her ovum every month. This method of stimulation is applied to women having no ovulation due to absence of own pituitary gonadotropins and to women in whom clomiphene ovulation induction gave no satisfactory results or was related to side effects. Gonadotropins are administered on an everyday basis in form of injection (using small insulin-type syringes or pre-filled pens) usually starting from day 2 of cycle with small doses. According to the selected protocol, the injections are continued for five more days (as in clomiphene induction) or until the ovulation day is determined (by measurements of LH or by chorionic gonadotropin administration). When gonadotropins are used to induce ovulation, the woman’s monitoring by serial ultrasonograms and measurements of blood estrogens should be meticulous and performed by experienced physicians to avoid risks arising from excessive ovarian response (such as ovarian hyperstimulation syndrome and multiple pregnancies)