Expensive, Inconvenient, Risky
If you've got PCOS, want to conceive, and haven't succeeded with Clomiphene, you may want to consider starting treatment with gonadotropins such as Pergonal, Humegon, or Metrodin. Treatment is expensive, inconvenient, and not without risks, but for many couples, these drugs do the trick: they get you ovulating, and help you get a baby. For some people, that's all that counts.
Treatment with gonadotropins is started between the third and fifth days of your cycle, and continued for 5-9 days, depending on how your body responds. The main goal of this type of drug therapy is to induce the production of multiple eggs. This, in turn, makes for higher hormone levels, which can explain the high rate of conception with the use of gonadotropins.
Clomiphene may result in the production of one or two eggs, but gonadotropins can produce scads of eggs; sometimes 30 or more. Because of the risks associated with multiple egg production, in particular for women with PCOS, it's the best that treatment be supervised by a doctor who is experienced with gonadotropin therapy.
While you are being treated with gonadotropins, your response to the medication will be monitored by observing estradiol levels, and with pelvic ultrasounds. With the miracle of ultrasound your physician can see how many follicles and eggs are developing. Follicles that manage to become 18mm in diameter have the best chance of having a mature egg contained therein. Ultrasound thus serves a dual purpose: it shows how many follicles and eggs you have and how many of them are mature and able to ovulate.
Estradiol levels can give clues about the health of your developing follicles. Once the follicles are mature, human chorionic gonadotropin (hCG) is administered which will help you to ovulate within the next 36-40 hours.
Clomiphene tricks the pituitary into increasing its stimulation of your ovaries, but gonadotropins direct their efforts straight to the ovaries. The result is seen in a dramatic increase in the level of estradiol and in enhanced cervical mucus production.
The two main risks associated with gonadotropins are enlarged ovaries and multiple births. Most of the time, unusual enlargement of the ovaries can be controlled by decreasing progesterone levels during the luteal phase. The danger of hyperstimulation remains a concern, especially for women with PCOS.
Women who get pregnant as a result of treatment with gonadotropins should be aware that 20% of such pregnancies result in twins. Most of us also know women who have had triplets as a result of such drug therapy, though since your progress will be monitored with ultrasound, an unacceptable number of follicles will signal your doctor not to treat you with hCG during that particular cycle. That's an expensive and heartbreaking decision, but sometimes a necessary evil.