Fortunately, there are many fertility drugs available to treat female infertility ranging from Clomid to injectable gonadotropins. Most of these drugs stimulate or regulate ovulation. Unfortunately, there are few cases where drug treatment of the male results in increased pregnancy rates. The rare male infertility condition resulting from extremely low levels of FSH and LH (hypogonadotropic hypogonadism) often responds to therapy but therapy requires three months and is very expensive. Other assisted reproductive technologies (IVF, ICSI) are usually more appropriate for the treatment of moderate to severe male infertility.
Clomid is often prescribed as a “first line” treatment by the obstetrician/gynecologist. Clomid is most likely to work within the first three ovulatory cycles and therapy beyond this time is usually not recommended.
Ovulation is controlled by a complex interaction of hormones controlled by the hypothalamus which is a small gland located at the base of the brain. The hypothalamus serves as the “hormone regulator” adjusting the various hormone levels during the ovulatory process.
At the beginning of the menstrual cycle, the hypothalamus releases gonadotropin releasing hormone (GnRH) which cause the pituitary to produce follicle stimulating hormone (FSH). FSH directly stimulates the recruitment and development of the ovarian follicles.
As healthy follicles develop they produce increasing amounts of estrogen which is monitored by the hypothalamus. The hypothalamus increases or decreases the production of FSH based upon this feedback.
Once the follicles mature, the hypothalamus releases GnRH to stimulate the pituitary to release a surge of luteinizing hormone (LH). LH finally prepares the eggs/follicles for ovulation which will occur 36 hours after the surge.
After follicular rupture, the structure remaining on the ovary is termed the corpus luteum and it begins to produce progesterone. Rising levels of progesterone are an indication of successful ovulation. Progesterone stimulates the development of the endometrium (lining of the uterus). The endometrium must thicken and become more vascular to support the developing embryo. After successful implantation and embryonic growth progesterone is produced by the placenta.