94. Ovulation Induction Without Guesswork: A Restorative Approach

What if the pill you were given to help you ovulate wasn’t actually helping—or even making things worse—and no one was checking? In today’s episode of Cycle Wisdom, Dr. Monica Minjeur reveals the often-overlooked truth about ovulation stimulation with medications like Clomid and Letrozole. You’ll hear Hope’s story—a 29-year-old nurse frustrated by impersonal care and harsh side effects—and how a personalized, restorative approach helped her conceive naturally.

Dr. Minjeur explains how conventional care often relies on guesswork and outdated protocols, while restorative reproductive medicine uses real-time hormone data, follicular ultrasound tracking, and individualized care plans to optimize ovulation and minimize risk. If you’ve ever felt lost in the fertility process or pressured to "just take a pill," this episode is for you.

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Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if the medication your doctor was giving you to help you ovulate actually wasn't working or worse yet? What if it was causing harm and no one was checking? Today we're diving into a topic that affects thousands of women trying to conceive, and that is ovulation stimulation with oral medications or pills. The way that restorative reproductive medicine uses these medications is a completely different approach rather than just prescribing and blindly guessing. Our treatment structure actually listens to your body, watches your hormones, and adjusts the plan in real time to achieve results that are safer and work with your body. So let's start off today with a story about a patient called Hope Now. Hope was a 29-year-old nurse who came to us with irregular cycles. She had been trying to conceive for over a year, and prior to finding our clinic, she bounced around between OB visits and a fertility consult, and she felt like a number. At one point she told me the doctor visited with me for about seven minutes. Handed me a prescription and told me to reduce my stress levels and get better sleep. Now that prescription was for a medication called Clomid and Hope did take the medication and after two months without a pregnancy and no labs or follow up, she noted that she had significant side effects and called her OB doctor back. She let them know that she had mood swings, bloating, and she still wasn't able to really identify any signs of ovulation. They recommended that she increase her dosage of Clomid, but hope didn't really like the sounds of that, especially since she had had so many significant side effects. After doing some research, talking with her friends and feeling like she had not been heard, she found Radiant Clinic and she learned that ovulation meds alone aren't always enough, that they have to be monitored and adjusted based on real-time hormone data. We also discussed that there is more to ovulation than just being put on a medication, and we worked together to identify four other factors that were playing a role with her fertility, including hormonal and metabolic components with personalized support. We worked together to develop a plan for very specific lifestyle changes that hope needed. Things like giving her guidance on exactly how much sleep and exercise she needed. We also discussed the role of dietary changes to help with decreasing inflammation and balancing her blood sugar and insulin levels to help improve her chances of natural ovulation. We did also prescribe some medications, and one of those medications we utilized was Letrozole, which we'll talk more about in a bit. Since we knew where her hormone levels were, I was able to start the medication at a dose that was appropriate for hope. And then we followed that up with hormone labs and follicular ultrasound scans throughout her cycle to adjust the dosing. Each cycle when needed. After just one cycle of this approach, hope ovulated for the first time in months and after just three medicated cycles. She was pregnant naturally. The targeted treatments, providing what her body needed and adjusting to optimize the hormone levels made all the difference in making sure that levels were just right and we were able to minimize side effects of medication, dosages that were too high or not the right fit. So what are ovulation stimulation, medications? How do they work and how are they used? Now, the two that most people have heard of are the oral medications or the pill versions, and these are Clomid or Clomophine Citrate and Letrozole or Femara. Primarily, we use these medications to help stimulate ovulation in women that have irregular cycles, PCOS, and ovulation or other conditions that can cause suboptimal hormone levels. Now, in many conventional clinics, these medications are prescribed with little to no follow follow-up. Sometimes there are labs that are rechecked, but oftentimes patients are left uncertain if they actually ovulated or if the dose was appropriate until they have their next follow-up. So there are also injectable medications that we can use for ovulation stimulation, and these are things like gonadotropins. Now, gonadotropins are designed to mimic FSH or follicle stimulating hormone or luteinizing hormone, and they work directly to stimulate the ovaries to develop follicles and release eggs. In restorative reproductive medicine, the injectable medications are not super commonly utilized, but we do use them in some individual situations. For today's podcast, we're going to be focusing just on the oral medications because they are the ones that are most commonly utilized. So the way that both Letrozole and Clomid work is they work to reduce estrogen, which will then trigger your pituitary gland in your brain to release more FSH or that follicle stimulating hormone in order to promote ovarian follicle development and ovulation to occur. Now there are some key differences between Clomid and Letrozole and in my world, we almost always utilize Letrozole first, and part of the reason for that is that Letrozole has less of a risk of a multiple gestation, so twins or triplets. Letrozole also has fewer side effects from a mood and hormone standpoint, and there's a bit more flexibility with that dosing. Certainly this isn't always the case, and there are unique situations where we do utilize Clomid either as first line or maybe if the Letrozole hasn't been working or is causing negative side effects. But in general, we typically are utilizing the Letrozole first. So before we would even decide that these medications are appropriate for you, our baseline evaluation is going to include that. Full hormone panel, so looking at all of your hormones, including the reproductive hormones, as well as thyroid, prolactin, and many other key players when it comes to that hormone evaluation. We also are doing a deep dive when it comes to your vitamin levels, your adrenal function, blood sugar, and insulin, and really looking to determine if there is something that is causing ovulation to not work appropriately. What is that? And trying to correct those underlying causes. We generally will also make sure that you have had an ultrasound and sometimes a hy of Celling agram done in order to assess anatomy. And make sure that your tubes are open. Ultimately, the goal here is to make sure that there are no other red flags before stimulating ovulation and to make sure that the medications we prescribe are the right fit for you. Because sometimes we're able to correct those ovulation patterns by fixing the underlying causes, and we don't even end up needing the ovulation stimulation medications. So if we decide that Letrozole or Clomid are the right fit for you, what do we do in order to make sure that that dosage is appropriate? Now one of the most important pieces here, and part of what sets us apart in restorative reproductive medicine is that we are tracking your hormone levels after you have ovulated. And ideally, this is seven days after ovulation to confirm that ovulation actually occurred, but more importantly, to assess the quality of that ovulation. So it's very common in conventional medicine to talk about checking a post peak or a post ovulation progesterone level. And oftentimes women are told that if their level is above three nanograms per milliliter, that since they see that surge in the progesterone, that yes, you have ovulated and you're good to go. However, when we look at cases of women on a cycle where they actually were able to conceive, we know that a progesterone level that is too low oftentimes can lead to miscarriage, and so instead, we want to make sure that we are achieving. Optimal levels of progesterone. Ideally focusing more in that range of 19 to 30 nanograms per milliliter at one week after ovulation. Estradiol levels are also important because that is a very important role when it comes to the thickness of the endometrium or the uterine lining, and if we don't have adequate estrogen, even if the progesterone levels are fine, implantation can be challenging if you don't have enough uterine wall thickness. So this is where the labs, every single cycle are really important in order to be able to help us to navigate if we need to adjust that dosage of the ovulation, stimulation, medication, or other medications we may be taking. For example, if our progesterone and estrogen levels are still too low, we may want to increase that dosage. If those levels are too high, we may want to decrease the dosage on the subsequent cycle. And this helps us to really be able to precisely determine what is the appropriate dosage that your body needs rather than just guessing. Another critical tool that we utilize is, is a follicle ultrasound scan. Now what we're doing with these ultrasound scans is to help ensure that we have growth and tracking that growth of the follicles. A follicle is the sac or the cyst that surrounds the egg that's going to be released. And so we wanna look at a couple of different things when we're doing these ultrasound scans. First of all, I want to ensure that only one to two mature follicles are developing. If you have two or more that are developing, there is a chance for twins, triplets, or more depending upon how many follicles actually open to release an egg. This also helps us to allow proper timing of ovulation identification, which is crucial for trying to conceive. F. We're also looking with these ultrasound scans to make sure that the follicle itself is growing appropriately and that it is an appropriate size around the time of ovulation. We also want to make sure that when we do that ultrasound scan that we're seeing ovulation has occurred when we're checking a scan after ovulation, and we wanna assess the endometrial lining or the uterine wall thickness to allow implantation to occur. So generally what this looks like is, is that when we have you charting your cycle, we're able to start to identify approximate patterns as to when you ovulate. We estimate trying to check an ultrasound scan about two to three days prior to ovulation, and then we assess how big that follicle is to determine when we're gonna do the next ultrasound scan. If it looks like that follicle is still small or immature, then we may assess an ultrasound again in a couple of days to see growth. We will then check again an ultrasound about two days after ovulation based on your charting in order to make sure that number one, the follicle has ruptured or released that egg. And usually that just means that it'll look like it's kind of squished down or it's not that perfect circle anymore. And number two, we want to assess the endometrial lining because again, that's what's going to be really important for making sure that implantation can happen after fertilization has occurred. So we get a lot of data by following this very closely on these follicle ultrasound tracking scans in addition to the lab monitoring that we're doing each cycle. Now, we don't check a follicle scan every single cycle, and typically we check it at least once or twice over the course of six to nine months. However, we do want to make sure we're tracking those labs every single cycle because that gives us a really good indication as to whether or not we need to adjust the dosage. And this is important because many women don't respond to standard dosages. So in restorative reproductive medicine, we adjust that medication dosage based on the lab and ultrasound feedback, not just based on guesswork and not just continuing to increase the dosage if you aren't pregnant in a certain cycle. So I just wanna take care of a few common misconceptions about these ovulation medications because unfortunately there's a lot of bad info out there. So one myth that we often bust is, I had to be on Clomid in order to get pregnant in the past, so therefore I must need it again. And this isn't always the case, unfortunately, we find that many women don't have an adequate workup or evaluation before they're started on these medications. And so it may not be that ovulation medication is what you needed. Now, it may have helped things along, but if it didn't correct the underlying dysfunction that was causing that ovulation imbalance, then perhaps correcting the underlying imbalance may mean that you don't need the medication at all. Another misconception we hear is that if I'm taking these ovulation induction medications, I must be ovulating. And again, that's not always the case. If you're not getting your labs checked or if you're not tracking your fertility awareness charting, you don't necessarily know that you are actually ovulating. And most importantly, if you don't have an ultrasound scan that is checking to make sure that that follicle releases, you can have what call a luff or a lutein unruptured follicle, which means that the hormone levels do do what they should be doing, and your charting may still look the same. But you may not have a follicle that's actually being released. So it's important to understand that there are multiple factors here that must be evaluated in order to understand if the medications are actually working. Another misconception we come across is oftentimes people are thinking Clomid is safer. It's been around longer, and the reality is, as I mentioned earlier on, that letrozole often has fewer side effects, and it typically does have better outcomes, especially in women with PCOS or polycystic ovarian syndrome. Again, we utilize Letrozole in probably 80 to 90% of the cases in our practice that require ovulation stimulation medications because it has fewer side effects, fewer chances of multiple births, and it is much easier to adjust the dosing because it comes in smaller pill increments. And then the final one that I hear probably the most often is that side effects on these medications are just part of the process and you need to deal with it. And this is absolutely not true. With proper monitoring and dosage adjustments, side effects can often be minimized or completely avoided. And again, oftentimes when women have these side effects, it may mean that it's because it's not the right thing that your body needs, or there may be other underlying things that are not being addressed. In most cases, ovulation medications are not the only thing that we utilize, and we oftentimes will supplement with either bioidentical progesterone or HCG injections after ovulation in order to help support your body's hormones in your luteal phase after you've ovulated. Now, this depends entirely upon what your hormone levels are and how your body responds to these medications, but it helps to make the environment more favorable for implantation and early pregnancy because we don't want to just see that positive pregnancy test just to end in miscarriage. We really want to make sure that we're optimizing all of those hormone levels so that we can go on to have a nice, healthy, full-term pregnancy. Ovulation medications can be powerful tools, but only when they're used with close follow up and real time monitoring. Restorative reproductive medicine ensures that you're not left in the dark, wondering if it's working. If you've been prescribed Clomid or Letrozole without having labs or follow-up follicle ultrasounds, it is okay to ask for more evaluation. You deserve a treatment plan that evolves with your body and to identify critical underlying factors that may be playing a role. Too often women are handed a prescription and told to just come back in a few months if it doesn't work out, but your hormones deserve more than guesswork. At Radiant Clinic, we take ovulation seriously because we know it's not just about getting a period. It's about finding a window to new life and restored health. Imagine if your fertility plan finally felt precise, peaceful, and personalized. This is how we can partner together to improve your health and promote fertility. If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach, please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.