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Houston Fertility Journal

    Ovulation Induction: What You Need to Know

    April 12, 2019 / by Center of Reproductive Medicine   

    Center of Reproductive Medicine


    Ovulation disorders play a role in 25% of infertility cases, making them one of the most common causes of infertility. It’s impossible to make a healthy baby without a healthy egg. Ovulation induction supports the woman’s body to effectively ovulate and can mean the difference between months of fruitless trying and a short journey to parenthood.

    If the woman doesn’t ovulate, pregnancy becomes impossible. Women who think they might have an ovulation issue should not delay treatment. Ovulation induction can be highly effective in the right person. It’s also one of the safest infertility treatments available. So is ovulation induction right for you? Here’s what you need to know about this common fertility treatment.

    What is Ovulation Induction?

    In theory, pregnancy is a simple matter of sperm fertilizing an egg. In practice, that often proves to be more difficult than you might expect. Women sometimes don’t ovulate at all, or only ovulate infrequently. When a woman does not ovulate, there is no chance that she can become pregnant. Women who ovulate infrequently have fewer chances of pregnancy. Because fertility declines with age, even a slight reduction in the number of chances a woman has to get pregnant in a year can greatly reduce her overall productivity.

    Ovulation induction steps in when nature falls short. Using hormones that are virtually identical to those the body produces (or should produce) on its own, ovulation induction induces the body to release an egg.

    In some cases, doctors use ovulation induction to ensure that a woman ovulates before in vitro fertilization (IVF) or another ART procedure. This allows a doctor to control the precise moment of ovulation and, in many cases, to encourage the woman’s body to release multiple eggs.

    Ovulation induction doesn’t necessarily have to precede IVF, though. Sometimes the only procedure a woman undergoes is ovulation induction. Here’s how it works:

    1. A doctor will come to the conclusion that a woman is not ovulating, not ovulating enough, or could otherwise benefit from controlled ovulation.

    2. The woman takes medication -- or, in some cases, a combination of medications -- to induce ovulation. The doctor will prescribe the proper prescription per each case.

    3. A doctor will then verify that the ovulation drug has worked. If it does, then the woman may use the medication for several cycles until she gets pregnant. If it does not work, a doctor may recommend another prescription or possibly another procedure.

    The most popular ovulation drug is called Clomid. This medication is remarkably safe and well-tolerated, but it does affect a woman’s hormones. Other ovulation drugs also affect hormones, so it is important to discuss benefits and risks before proceeding with ovulation induction.

    Ovulation Disorders: The Basics

    So who should consider ovulation induction? Ovulation induction is a good choice for anyone with ovulation disorders.

    Some common ovulation disorders include:

    • Pituitary gland disorders. Pituitary tumors and any other condition that affects the pituitary may cause a woman not to ovulate.


    • Polycystic ovary syndrome (PCOS). The most common ovulation disorder, this condition can cause a woman not to ovulate at all, or to ovulate irregularly. Women with PCOS may also be insulin resistant, overweight, and have excess body hair.
    • Low body weight and eating disorders. Women who are too thin may not ovulate, or may only ovulate irregularly. When weight is the culprit, the safest strategy for getting pregnant is to gain weight.
    • Diabetes and insulin resistance. Diabetes can affect the body’s endocrine system, throwing hormones out of whack. This may delay or suppress ovulation.
    • Diminished ovarian reserve. Women with a diminished ovarian reserve may ovulate less frequently, or not at all.
    • Unexplained infertility. Sometimes a doctor cannot find the cause of an ovulation disorder. In these cases, ovulation induction may help.

    Sometimes a woman has a temporary condition that interferes with ovulation. Following the removal of an IUD, for example, it may take a woman several months to resume normal ovulation. If a woman is in her thirties or forties, time is of the essence. So a doctor might recommend ovulation induction to speed things up.

    Some ovulation disorders may affect fertility in other ways. For example, women with hormonal issues may also not produce enough progesterone to sustain a healthy pregnancy. So it’s important to get a comprehensive diagnostic workup. Being diagnosed with an ovulation disorder does not mean that the absence of ovulating is the only, or even the primary, cause.

    Ovulation Induction for Women Who Already Ovulate

    Ovulation induction is an affordable treatment, making it an affordable option that a doctor may recommend even for women who ovulate.

    In many cases, a woman ovulates, but less frequently than she should. The average menstrual cycle is 28 days, but some women have cycles that are 35 days, 40 days, or even longer. Over the course of a year, this can add up to two or more fewer shots at getting pregnant. Inducing ovulation can improve a woman’s chances.

    In other cases, a woman ovulates or appears to ovulate normally, but still can’t get pregnant. If testing her partner uncovers no serious problems, a doctor might still recommend ovulation induction. This allows the doctor to control the precise day of ovulation, which may help the woman and her partner appropriately time intercourse, thereby increasing the odds of a successful pregnancy.

    It’s important to bear in mind that ovulation induction is not a one size fits all treatment. So you shouldn’t just go to your gynecologist and ask for Clomid. In the wrong person, ovulation induction may even delay effective treatment. Only a fertility specialist can help you determine whether ovulation induction is the right course of treatment for you. So don’t delay seeking help. Fertility comes with a ticking clock, and the sooner you seek help, the sooner you can become pregnant.

    Signs of Ovulation Problems


    When a woman has her period but does not ovulate, this is called an anovulatory cycle. It’s impossible to diagnose ovulation problems based on symptoms alone, but knowing the symptoms can encourage some women to seek help earlier.

    Some warning signs to look for include:

    • Getting positive ovulation predictor kit results several times a month. An ovulation test cannot actually test for ovulation. It only tells you that your body is trying to ovulate. So if you produce hormones to ovulate several times a month, it might actually be a sign that your body is trying, but failing, to ovulate.
    • Never getting a temperature spike when you chart your basal body temperature. Even if you get a positive test on an ovulation predictor kit, the lack of a temperature spike suggests you might not have ovulated.
    • Irregular menstrual cycles. If your cycles are longer than 35 days, it may mean you are not ovulating. Cycles shorter than 21 days may also indicate a problem with ovulation. If your cycles vary greatly in length from month to month, this may mean you’re either not ovulating or only ovulating some months.
    • Very light periods.
    • Getting a positive result on an ovulation predictor test, and then getting a period six or fewer days after the test.
    • Not having any typical signs of ovulation, such as fertile cervical fluid.
    • A change in your menstrual cycles. This could indicate a hormonal imbalance, or that you are moving toward menopause. See a doctor right away for unusual menstrual cycles that are not part of your usual pattern.
    • Not getting a period at all, or only getting a period every few months.

    The most important sign of all is trying for many months without a pregnancy. Women who are over 35 and try longer than six months without success should see a fertility specialist. If the woman is under 35, see a fertility specialist after a year, or immediately if you have any of the above symptoms.

    How to Get Tested for Ovulation Problems

    Treatment for ovulation problems begins with a comprehensive diagnostic workup. A doctor will want to test hormone levels to see if your body is producing the right hormones at the right time. This usually means a blood test at specific points during your cycle.

    A doctor may also want you to track your cycles and take your basal body temperature each morning. This can help establish your usual pattern and provide details about what might be going wrong. For example, a very short luteal period -- the time after you ovulate -- suggests there may be a hormone imbalance that undermines implantation rather than ovulation.

    If a doctor determines that you’re not ovulating, they may want to perform additional tests to determine why. Talk to your doctor about the relative benefits and risks of these tests. It’s also important to get tested for other fertility issues. Perhaps most importantly of all, your partner must be tested. Otherwise, you might induce ovulation but have zero chance of pregnancy because there’s an issue with your partner’s sperm. Diagnosing this before you pursue ovulation induction can save you time, money, and heartache.

    Does Ovulation Induction Work?

    If you’ve already tried for months or years to get pregnant, you may be skeptical of fertility treatments. When you’re used to failure, success can feel far out of reach. But ovulation induction is one of the most effective fertility treatments available.


    To improve the effectiveness of ovulation induction:

    • Have a comprehensive diagnostic workup to ensure there are no other issues.
    • Get your partner tested, to ensure there are no issues with their sperm and they will effectively be able to reach your egg.
    • Ensure you correctly time intercourse. For most couples, the day before ovulation -- not the day after ovulation, contrary to popular belief -- is the most fertile day.
    • If you use a lubricant, use a sperm-friendly lubricant.
    • Ask your doctor if there are any lifestyle strategies that might improve your fertility.

    For most healthy couples, each cycle has a 15-30% chance of success. Your chances of success depend on your age, overall health, and whether you have any other fertility issues. But if your primary or sole issue is not ovulating, ovulation induction is highly effective and may result in a pregnancy in just a few cycles.

    Sometimes ovulation induction fails to induce ovulation. If this happens, a doctor may recommend additional treatments. If the woman still cannot ovulate, she may need to use donor eggs.

    If you’re able to successfully ovulate with ovulation induction but still do not get pregnant, a doctor may recommend a number of strategies. One of the most effective is intrauterine insemination. During this procedure, a doctor fertilizes the egg with your partner’s sperm inside your body. It’s less invasive than IVF, but with a similar success rate for healthy women. If IUI and other treatments fail, a doctor may recommend IVF or the use of donor sperm.

    The important thing to keep in mind is that fertility treatments take time. Even if the first treatment fails, the next cycle may work. And there’s almost always another treatment option to try. So before you consent to any treatment program, spend some time discussing with your doctor your various treatment options. It’s important to get a comprehensive view of treatment and to ask questions about how effective any given option is likely to be. This can help you budget for treatment while supporting you to make informed decisions.

    Choosing a Fertility Specialist for Ovulation Induction

    Ovulation induction is a powerful weapon in the fertility arsenal. Don’t waste your time, money, and emotional resources on a treatment plan that’s doomed to fail. While you might be tempted to seek treatment from your general practitioner, only a fertility specialist has the knowledge that is necessary to shorten the timeline to a pregnancy.

    At the Center of Reproductive Medicine, in Houston, Texas, we deeply empathize with our patients. We understand how painful fertility issues can be. We also know that there is hope. Let us work with you to become a parent as quickly and safely as possible. We’ll work within your budget and listen to your values. We’ll refer you to support groups and provide help when you need it, and always offer a shoulder to cry on.

    You don’t have to struggle alone. Put your fertility in the hands of a true expert. When doctors have fertility questions, they come to us. We know the research, know the science and know the facts. Let us put our experience to work for you. Contact one of our Texas fertility center locations today.

    The Infertility Journey: Your Questions from A to Z

    Topics: Fertility Specialist, Infertility Treatment, Ovulation Induction

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