Infertility Treatment: Ovulation Induction and Insemination

For the majority of infertility patients, ovulation induction is the initial therapy. Treatment is individualized for a couple based on ovarian reserve testing, semen analysis, and the presence of anatomic pathology. Candidates for ovulation induction include those who are anovulatory and couples with unexplained infertility. The majority of patients diagnosed with anovulation have polycystic ovarian syndrome. Treatment options include clomiphene citrate and letrozole. For patients with hypogonadotropic hypogonadism, treatment involves injections with gonadotropins. Treatment is typically combined with intrauterine insemination to maximize pregnancy rates, especially in patients with male factor infertility or unexplained infertility. A stepwise approach is necessary, as patients who are unsuccessful with less invasive and costly treatments may eventually require in vitro fertilization. This review contains 7 figures, 3 tables and 57 references Key Words: clomiphene citrate, gonadotropins, infertility, intrauterine insemination, letrozole, ovulation induction, polycystic ovarian syndrome, unexplained infertility