Ovulation Induction and Superovulation

Women who don’t ovulate due to polycystic ovary syndrome (PCOS) or other conditions will usually need medication to help their ovaries release eggs. Ovulation induction is the term used to describe the use of injectable fertility drugs (gonadotropins) to stimulate the ovaries to produce a mature egg or eggs.

In some cases, you may be ovulating but still not getting pregnant. Your chance of conceiving could be improved by using medication to stimulate your ovaries to release multiple eggs. This procedure is called superovulation.

Both ovulation induction and superovulation use one of these medications:

  • Clomiphene
  • Letrozole
  • Gonadotropin injections

When to Consider Ovulation Induction or Super Ovulation

Ovulation Induction and Super Ovulation might help you get pregnant if:

  • You have ovulation problems that have not responded to simpler medications (such as clomiphene tablets)
  • You have unexplained infertility and wish to try superovulation therapy in order to increase the number of eggs produced in each cycle, thus increasing the chance of conception

To be a candidate for ovulation induction you must have a normal uterus, at least one normal fallopian tube, and your partner must have a normal sperm count. If your partner does not have a normal sperm count or if you do not have a male partner, you can use donor sperm.

How Does OI and SO work?

During a natural menstrual cycle, you release fertility hormones (LH & FSH) from your pituitary gland – causing the growth of a follicle (the fluid space in the ovary where the egg grows). Although several follicles grow each month, in a natural cycle only one becomes mature enough to ovulate its egg.

With ovulation induction, you take fertility drugs to stimulate the growth of multiple eggs. During your treatment, we will carefully monitor you with blood tests and ultrasounds in order to minimize complications such as ovarian overstimulation or multiple births.


1. Fertility drugs may be administered to stimulate the growth of two to three eggs to maturity. Typically, Clomiphene Citrate, Letrozole pills, or gonadotropin injections are used to stimulate the growth of follicles.
2. Monitoring or urine testing is conducted to measure the growth of follicles and the LH surge. Because fertility drugs can produce multiple eggs, monitoring may be needed to reduce the risk of multiple births. Blood tests measure estrogen concentrations, and ultrasound is used to measure follicular development.
3. When the blood tests and ultrasounds indicate 2 to 3 follicles are mature, we may administer a second medication called hCG (human chorionic gonadotropin) to trigger ovulation if you don’t surge on your own. You will usually ovulate 36 to 48 hours after this final injection.
4. If your treatment plan involves intrauterine insemination (IUI), it is done on the morning you ovulate. At this time, the sperm sample is prepared for the IUI and injected later the same day. The washed and concentrated sperm sample is inserted through the cervix, into the uterus. The IUI procedure is generally without discomfort and uncomplicated.
5. Pregnancy testing and early ultrasound monitoring are conducted at appropriate intervals.

Side Effects

Your usual menstrual period symptoms may be exaggerated, and you may experience bloating, breast tenderness, cramping, pelvic twinges or heaviness, fatigue, and headaches.

How Successful is OI

Typically, 20%-25% of healthy, fertile couples become pregnant each month they try. In contrast, the pregnancy rate among couples with infertility is usually between 2%-5% per month.
Superovulation usually produces pregnancy rates of 10%-20% per cycle, depending on a woman’s age, diagnosis and duration of infertility.
Among women with certain ovulatory disorders, ovulation induction treatment may even restore normal fertility rates of 20%-25% per month. If you do not become pregnant within the first three treatment cycles, we will discuss other treatment options with you.
Approximately 15%-20% of gonadotropin pregnancies will miscarry, which is similar to the general population. There is no increase in the risk of congenital abnormalities, ectopic pregnancies, or birth defects as compared to other women your age.


  • Overstimulation
  • Multiple pregnancies
  • Ovarian Hyperstimulation Syndrome (OHSS)
  • Cancelled Cycle

While most women produce one to four mature follicles during this treatment, in some cases the ovaries over stimulate and produce too many mature follicles. We try to minimize this by frequent monitoring and dose adjustments.
Although ovulating more than one egg may increase your chances of conceiving, it will also increase your chances of having a multiple pregnancy.

In about 0.5-1% of cases, ovarian hyper stimulation syndrome (OHSS) develops when the ovaries become extremely enlarged and extra fluid accumulates within the abdomen.


There are two main costs to OI and SO: the clinic fees and medication fees. Our fee schedule is here.

How do I get started?

After your first appointment, you will meet with your nurse to learn how to take the medications and establish the scheduling of your treatment.