- Cycle-monitoring without hormonal therapy: is performed to assess if an ovulation in the natural cycle occurs
- Cycle-monitoring with hormonal therapy: If there is no ovulation in the natural cycle you can induce ovulation with a hormonal therapy (Clomiphen or Gonadotropins) and trigger exactly the time of ovulation
Clomiphene Citrate (Clomiphen):
Clomiphene is used to stimulate ovulation, increase ovarian progesterone secretion during the second half of the cycle, and make menstrual cycle lengths more predictable. Clomiphene is taken orally once or twice a day for 5 days.
When these gonadotropins (FSH, HMG) are administered, they augment the natural pituitary FSH to stimulate follicle growth. The primary mechanism of fertility enhancement is through the stimulation of multiple follicles (i.e. multiple eggs). Visualizing the ovaries by ultrasound allows determination of the number and size of the follicles in each ovary. When it is determined that the follicles should contain mature eggs, an injection of HCG (human chorionic gonadotropin – the hormone of pregnancy) is given. Ovulation usually occurs approximately 34 – 42 hours after the injection.