Ovarian Hyperstimulation

The Next Step After Clomid

When a woman undergoes treatment for infertility and the use of clomiphene citrate is ineffective, the next step may be to have medications injected on a daily basis to induce ovulation. Gonadotropins, injectable fertility medications which contain follicle stimulating hormone, are used to generate the development of follicles in women who do not ovulate.

More than 90 percent of women who are anovulatory-do not ovulate-experience ovulation with this type of therapy. When younger women are treated with gonadotropins, the pregnancy rates are much higher than with the use of Clomid, as are the rates of pregnancy through intrauterine insemination. After a period of six to 12 months, if no pregnancy occurs, then in vitro fertilization may be considered.

When injectable gonadotropins are used, ultrasound and blood monitoring of the stimulation cycle is important since there can be substantial risks that come along with ovarian stimulation. The monitoring should be done twice or three times in a week to ensure safety for the woman.

The Risk Of A Multiple Pregnancy Using Gonadotropins

Another effect of using gonadotropins is the possibility of a multiple pregnancy. Generally, 75 percent of assisted pregnancies are single, 20 percent are twins, five percent are triplets and one percent is quadruplets or more. In very rare cases, nine or more fetuses have been seen on an ultrasound and very recently the second only multiple birth of eight babies, all born live, was seen in the United States. It is considered very rare that a pregnancy of more than five fetuses will result in live, viable births unless selective abortion is performed between the third and fourth months of gestation.

How Can I Avoid A Multiple Pregnancy?

When there are many mature follicles present, the couple and the doctor can discuss the potential of a multiple pregnancy and opt out of a cycle by not administering the injection that month. Another option to avoid a multiple pregnancy is to have in vitro fertilization with blastocyst transfer which can ensure the presence of only one or two eggs and thus address the issue of a multiple pregnancy and the associated risks.

Use Of Bromocriptine Therapy In The Treatment Of High Prolactin

If a woman's anovulation is caused by a high level of the hormone prolactin, she may be treated with a drug called bromocriptine. This type of disorder is rare and it causes amenorrhea, the absence of menstruation. For women with a mild to moderate elevation of prolactin, bromocriptine can be effective in reducing the levels to normal thus allowing for ovulation every month. If a woman has very high levels of prolactin, she will probably not respond to bromocriptine therapy. Special screening of the pituitary gland, done by CT scan or MRI, is important in such cases to rule out the possibility of a significant tumor. High prolactin does cause a benign tumor of small size called prolactinoma. The smaller tumors can be managed with bromocriptine whereas the larger ones require more aggressive treatment.


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