Our fertility experts at locations including NYU Langone’s Fertility Center and NYU Langone Reproductive Specialists of New York may prescribe medications that induce or enhance ovulation. Also known as fertility drugs, these medications can stimulate the ovaries to release multiple eggs during a menstrual cycle, which is sometimes called controlled ovarian hyperstimulation, or superovulation. This can improve the likelihood that one or more eggs become fertilized, which can increase the odds of pregnancy.
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Your doctor determines which medication and how much to prescribe based on your individual needs. Common medications taken orally include clomiphene citrate (Clomid®) and letrozole (Femara®). Both are administered for approximately five days, beginning on the third or fifth day of your menstrual cycle. They tend to produce one to three mature eggs, or oocytes, per cycle. After taking the medication, the ovulatory response is usually monitored by several blood tests and ultrasound examinations.
Injectable medications used to stimulate superovulation include gonadotropins, hormones that are typically administered by daily shots for 8 to 10 consecutive days, starting on day 2 of a woman’s menstrual cycle. Our experts can teach you how to give yourself an injection at home.
Superovulation caused by injectable medications is generally a stronger form of fertility treatment than medications taken orally. It requires more frequent doctor visits for ovarian monitoring. This monitoring is performed to prevent an excess number of eggs from developing and being released from the ovaries at the same time.
Superovulation increases the odds for multiple pregnancy, though the odds of multiple birth decrease as a woman ages. During your consultation, if medication treatment is advised, your doctor discusses the risk for a multiple birth and helps control for it.
Sometimes, more eggs develop in response to medication than the treating physician anticipates. When this happens, the cycle may be canceled or, alternatively, converted to an in vitro fertilization cycle, in which the stimulated eggs are retrieved from the body rather than allowed to be released into the fallopian tubes. In vitro fertilization involves fertilizing the eggs outside the body, culturing the resultant embryos, and implanting one or two of the best quality into the uterus. Our experts most often now implant only one embryo at a time, nearly eliminating the risk that more than one embryo implants and develops.
With all fertility treatments, the younger the age of the egg, the greater the likelihood of a successful pregnancy. Although pregnancy remains a possibility when using eggs from a woman older than age 41, the chance of success is significantly decreased as compared to results using the eggs of a younger woman. Newer technologies, such as egg freezing, also known as oocyte cryopreservation, allow a woman to preserve her eggs at a younger age for later usage.
In addition, preimplantation genetic screening (PGS) permits NYU Langone doctors to identify embryos that have the greatest chance of creating a healthy pregnancy. Both egg freezing and PGS technologies can help circumvent issues related to age-related infertility.
Intrauterine insemination, or IUI, is often recommended along with fertility medications. This procedure is always recommended when a woman does not have a male sexual partner and is using frozen, donated sperm in order to achieve pregnancy.
In the IUI procedure, a sample of semen is “washed,” meaning seminal fluid is separated from sperm cells to filter out abnormal cells and dead sperm, providing a high concentration of healthy sperm for insemination.
Before this procedure, your doctor often monitors you for ovulation with blood tests and, sometimes, ultrasound to assure accurate timing of the sperm introduction. Alternatively, some women receive IUI using their natural ovulation cycle. During these treatments, optimal timing can be determined either by blood and ultrasound testing in your doctor’s office or by using a store-purchased ovulation monitoring kit.
When proper timing is determined, insemination is performed. The doctor inserts a speculum into the vagina to separate the walls and advances a thin, flexible catheter through the cervix and into the uterus, where the washed sperm sample is gently injected.
The process takes only a few minutes. You can resume normal activities within 10 minutes of the procedure. You may experience temporary, mild cramping.
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