A Patient's Guide to Inducing Ovulation

Clomiphene citrate and gonadotropins can result in symptoms related to ovarian enlargement. Abdominal distension and discomfort may occur as can breast tenderness. Occasionally, women taking clomiphene citrate experience hot flashes. Other side effects include headaches, visual disturbances, and mood swings.

Ovarian hyperstimulation syndrome is another side effect that a woman might experience. It is a very serious and potentially lethal disorder. The incidence of ovarian hyperstimulation syndrome, also known as OHSS, is less than 3 to 5 percent of patients undergoing ovulation induction. It is much less common following clomiphene citrate than gonadotropin use.

OHSS involves enlargement of the abdomen and and accumulation of fluid in the abdomen and pelvis. It also is associated with nausea, vomiting, and difficulty breathing. Rarely, serious complications involving the liver, the kidney, and the lungs may occur. Because of the seriousness of this disorder, it is far better to prevent the occurrence of this syndrome than managing its consequences. Therefore, careful monitoring with ultrasound examinations and blood tests is crucial in assessing the risk of patients undergoing ovulation induction.

Finally, there is still debate on whether prolonged use of ovulation induction agents results in an increased risk of ovarian and breast cancer, though such a risk is minimal in women who eventually conceive and deliver.


I hope that this discussion has been helpful in answering some of your questions regarding ovulation induction. I strongly recommend that you ask your physician about his or her qualifications and board certification prior to commencing therapy, and discuss with him or her any concerns you might have.

Dr. Fayek Nicholas Shamma, board certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility, is the Associate Director of Ann Arbor Reproductive Medicine Associates, the Toledo Fertility Center, and the Mid-Michigan Fertility Center. He is also an assistant professor at Michigan State University College of Human Medicine. Dr. Shamma trained in Obstetrics and Gynecology at Yale New Haven Hospital in New Haven, CT, where he also went on to do sub-specialty training in Reproductive Endocrinology and Infertility. In his practice, Dr. Shamma takes care of patients with a variety of infertility problems. He routinely performs ovulation induction and in-vitro fertilization. He also performs other types of assisted reproductive procedures, including the use of donor eggs or embryos, the injection of sperm into female eggs, and the use of gestational surrogacy. As an infertility surgeon, he also performs various corrective surgeries related to infertility.

Dr. Shamma has written many articles in professional journals on the topics of infertility and in-vitro fertilization. He has also presented several studies in the area of ovulation induction and in-vitro fertilization at major national and international medical meetings.

Copyright © Fayek Nicholas Shamma. Permission to republish granted to Pregnancy.org, LLC.


Polycystic ovarian syndrome

This is a more common syndrome in which the brain can produce FSH and LH, but the ovaries do not respond normally to these hormones, and therefore do not develop a mature egg each month. Doctors call the inability to produce an egg each month "chronic anovulation".

Polycystic ovarian syndrome usually occurs in women who are overweight and have excess body hair, oily skin, and sometimes acne. Such women will not produce the ovarian hormones estrogen and progesterone which are necessary for the uterus to produce a menstrual period each month. As a result, they have long and irregular menstrual cycles or no menstrual periods whatsoever.

One of the recent advances in polycystic ovarian syndrome is the finding that some of the women with this syndrome have a high insulin level in their blood, a condition known as hyperinsulinemia.