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Superovulation

Ovulation inductions are used when patients don't ovulate, as a pregnancy acceleration technique by itself, or as part of a more complex pregnancy acceleration technique like IVF. The most commonly used drug for ovulation induction is clomiphene citrate. Superovulation refers to the use of (currently) injectable medications containing the hormone FSH.

FSH containing medications

A very important tool in infertility is the use of gonadotropins. These drugs include Follistim, Gonal F, Braville, Menopur, and Repronex. This class of medications can be used in a number of ways with and without other medications. Our objective in using these drugs is either to improve egg quality and/or increase the availability of the number of eggs to be produced. Although we use these drugs in several ways, our therapies are always individualized to a patient's response. The drugs we currently use are injectable mdeications taken once or twice a day for 5 to occasionally as much as 15 days. The injection involves very fine short needles and small amount of medication. Some of our patients start the process "needle phobic", but we have never had anyone who could not overcome there fear of these injections.

One of our primary approaches is a low dose medication approach ususally in comjuction with clomiphene citrate or letrozole. We believe that this works primarily because it improves egg quality and corrects minor degrees of ovarian dysfunction. My initial experience utilizing this method was published several years ago.
[ bibliographical reference ] The patient population using this therapy is diverse in terms of their infertility history, age, and extent of their work-up. (For example, have they had a recent laparoscopy?) It is thus difficult to estimate success rates, but a good starting point estimate would be 1/4 to 1/3 of the take home baby rate per IVF procedure for that patient's age category.

The other common method we utilize is a more aggressive ovulation where we generally try to maximize egg number and utilize a combination of gonadotropins and a medication like Lupron or Ganirelix. The ovulation induction that we use in this sense is very similar to the one that we use prior to an in vitro fertilization cycle.

Based on the literature we usually combine superovulation with IUI because we feel that it makes the pregnancy rate about 25% higher than it would otherwise be. This is likely due to several factors. Since IUI delivers more sperm to the egg, it likely compensates for partially recognized or unrecognized sperm factors. Importantly, it also partially compensates for endometriosis (treated and untreated).