Should I Try Ovulation Induction Before Other Fertility Treatments?

By Halle Tecco, MBA, MPH

Couples who struggle with infertility often face the difficult decision of when to seek fertility treatments. Given the time and expense of various fertility treatments, many wonder where and when to start. 

One common first step is ovulation induction, a treatment that may be recommended for those who have difficulty ovulating regularly or have unexplained infertility. [1] This treatment involves using medications to stimulate the ovaries to produce mature eggs, increasing the chances of pregnancy. [1] In this article, we will explore the advantages and disadvantages of ovulation induction and answer common questions about its effectiveness and timing in relation to other fertility treatments.

What is the advantage of induced ovulation?

Induced ovulation, also known as ovulation induction, is a common treatment for infertility that involves using medications to stimulate the ovaries to release one or more mature eggs. [1] The advantages of induced ovulation are many, especially for women with irregular menstrual cycles or those who do not ovulate at all. [1] By inducing ovulation, these women have a better chance of conceiving naturally.

Find out if you’re ovulating with our free ovulation quiz, ovulation testing kits, or learn more about irregular ovulation on the Natalist blog. 

Ovulation induction can also be used in conjunction with other fertility treatments, such as intrauterine insemination (IUI). By increasing the number of mature eggs available for fertilization, ovulation induction can improve the chances of success for these treatments. [1] This treatment is also less invasive and less expensive than other fertility treatments, making it a good option for couples who want to try less aggressive treatments before moving on to more invasive procedures. [2] 

Should I try ovulation induction before IVF?

Many people choose to try ovulation induction medications (like Clomid®) as a first step when struggling to conceive. This is because in-vitro fertilization (IVF), which involves retrieving multiple eggs from the ovaries, can be expensive, time consuming, and invasive. [2]  Find out the differences between IVF and IUI → 

But will it work? Success rates for fertility drugs can depend on multiple factors, including the medication. For example, after three cycles of clomiphene, approximately 80% of women will ovulate, and 30-40% will become pregnant. [3]

Is it good to induce ovulation?

Ovulation induction is generally considered a safe and effective treatment for infertility. However, like any medical treatment, there are potential risks and side effects to consider.

Common side effects of ovulation induction medications (specifically Clomid® and letrozole- a breast cancer medication used off-label for ovulation induction) include [1,4]:

• Hot flashes
• Headaches
• Nausea
• Mood swings
• Breast tenderness
• Additionally, side effects can include abdominal pain, vision disturbances, cancer, congenital abnormalities (clomiphene only), bone density loss (letrozole only), multiple pregnancies, or kidney damage after prolonged use. [1,5]

Ovarian hyperstimulation syndrome (OHSS) is a rare but serious condition that can occur with ovulation induction medications, especially in women who are at a higher risk for OHSS, such as those with polycystic ovary syndrome (PCOS). OHSS can cause enlarged ovaries, abdominal pain, and fluid accumulation in the abdominal cavity. In rare cases, it can be life threatening. [7]

Is it better to ovulate before or after IUI?

IUI is a fertility treatment that involves placing washed sperm directly into the woman's uterus at the time of ovulation. The timing of IUI is crucial, as it must be performed within a specific window of time when the woman is most fertile. [8] 

In most cases, ovulation is induced before IUI. This is because ovulation induction can help ensure that the woman ovulates at the optimal time for IUI. By inducing ovulation, the provider can time the IUI procedure more accurately, increasing the chances of success. [8]

However, in some cases, the woman may ovulate naturally without the need for ovulation induction. In these cases, the timing of the IUI procedure may be determined by monitoring the woman's natural cycle with ultrasound and hormone tests.

Does ovulation induction improve egg quality?

While ovulation induction can improve the chances of conception by increasing the number of eggs available for fertilization, it is not clear whether it directly improves egg quality. [6]

Egg quality refers to the health and viability of the eggs released during ovulation. Factors that can affect fertility and egg quality include a woman's age, genetics, lifestyle factors such as smoking and diet, and certain medical conditions such as polycystic ovary syndrome (PCOS). [9] While ovulation induction can help improve the chances of conception, it does not address underlying issues that may be affecting egg quality. [6]

Read What Supplements Can Help With Low Egg Quality?

How long does it take to get pregnant with ovulation induction medication?

One study looked at using letrozole to stimulate ovulation in those with PCOS. The average time to become pregnant with letrozole was 90 days, or about three cycles. About 28% of women taking letrozole resulted in a live birth in the study. [4]

Another study found that Clomid® can induce ovulation in 80% of anovulatory women. However, this doesn’t always lead to pregnancy. Pregnancy rates per cycle can be 10-20% and as high as 60% after six cycles and 97% after 10 cycles. So, it may take anywhere from one month to a year to get pregnant with Clomid®, if at all. [10]

Why ovulation induction is a great first option

Ovulation induction medication is a great first step for someone trying to get pregnant because it can help stimulate ovulation and increase the chances of conception. Ovulation induction medications work by regulating the hormones that control the menstrual cycle and promote the development and release of eggs from the ovaries. These medications are particularly helpful for those who have irregular cycles or ovulation disorders such as PCOS. By regulating ovulation, ovulation induction medications can improve the timing of intercourse and increase the likelihood of pregnancy. Additionally, ovulation induction medications are relatively safe and non-invasive, making them a great first step for couples who are just starting to explore their fertility options. 

Key Takeaways

• Ovulation tests can help you determine if you’re experiencing regular ovulatory cycles.
• A common first step in fertility treatment is ovulation induction, especially for those who have difficulty ovulating regularly 
• Ovulation induction involves using medications to stimulate the ovaries to produce mature eggs, increasing the chances of pregnancy
• Clomid® and letrozole are two popular ovulation induction medications
• Ovulation induction is generally considered a safe and effective treatment for infertility
• While ovulation induction can improve the chances of conception by increasing the number of eggs available for fertilization, it is not clear whether it directly improves egg quality

Sources:

1. Medications for Inducing Ovulation, A Guide for Patients.AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE. Revised 2016. URL. 
2. Tjon-Kon-Fat RI, Bensdorp AJ, Bossuyt PM, et al. Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?. Hum Reprod. 2015;30(10):2331-2339. doi:10.1093/humrep/dev193
3. Homburg R. Clomiphene citrate--end of an era? A mini-review. Hum Reprod. 2005;20(8):2043-2051. doi:10.1093/humrep/dei042
4. Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome [published correction appears in N Engl J Med. 2014 Oct 9;317(15):1465]. N Engl J Med. 2014;371(2):119-129. doi:10.1056/NEJMoa1313517
5. CLOMID® (clomiphene citrate tablets USP). U.S. Food & Drug Administration. Reference ID: 3206435. URL. 
6. Sharma M, Balasundaram P. Ovulation Induction Techniques. [Updated 2023 Mar 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574564/
7. Mbi Feh MK, Wadhwa R. Clomiphene. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559292
8. Cantineau AE, Rutten AG, Cohlen BJ. Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility. Cochrane Database Syst Rev. 2021;11(11):CD005356. Published 2021 Nov 5. doi:10.1002/14651858.CD005356.pub3
9. Sharma R, Biedenharn KR, Fedor JM, Agarwal A. Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol. 2013;11:66. Published 2013 Jul 16. doi:10.1186/1477-7827-11-66
10. Seyedoshohadaei F, Zandvakily F, Shahgeibi S. Comparison of the effectiveness of clomiphene citrate, tamoxifen and letrozole in ovulation induction in infertility due to isolated unovulation. Iran J Reprod Med. 2012;10(6):531-536.