Infertility is a disease in which the ability to get pregnant and give birth to a child is impaired or limited in some way. For heterosexual couples (man and woman), this is usually diagnosed after one year of trying to get pregnant (but maybe diagnosed sooner depending on other factors). For heterosexual couples, one-third of the causes of infertility are due to a male problem, one-third are due to female problems, and one-third are due to combination or unknown reasons. When the cause of the infertility is found to come from the female partner, it’s considered female infertility or “female factor” infertility. Infertility is a common disease. At least 10% of women deal with infertility of some kind. The chances of being infertile increase as a woman ages.
There are many reasons why a woman may not ovulate (release an egg) regularly. Hormonal imbalances, a past eating disorder, substance abuse, thyroid conditions, severe stress, and pituitary tumors are all examples of things that can affect ovulation.
What is Clomid?
Clomid (aka Clomiphene Citrate, Serophene, Cloramifen) is widely used in infertility and has helped millions of women ovulate. It is a proven fertility drug discovered back in the 1960s and acts as a selective estrogen receptor modulator (SERM). This means that it attaches to receptors generally reserved for estrogen. The main effect is to increase the Follicle Stimulating Hormone (FSH) levels naturally. The increased FSH levels directly stimulate the ovary to mature and ovulate eggs. It can be used for ovulation induction alone or in combination with other infertility treatments like IUI and IVF.
Clomid works by making the body think that your estrogen levels are lower than they are, which causes the pituitary gland to increase secretion of follicle-stimulating hormone, or FSH, and luteinizing hormone, or LH. Higher levels of FSH stimulate the ovary to produce an egg follicle, or multiple follicles, that will develop and be released during ovulation. High levels of LH stimulate ovulation.
Clomid is often prescribed by primary care physicians or OB-GYNs before they refer a couple to see a fertility specialist for more specialized care. Some reproductive specialists prescribe Clomid as well.
How to take Clomid?
If periods are regular
- On the third day of your cycle (The first day is the day you have a menstrual flow and not just light spotting) start Clomid at 50mg (one tablet) per day for five days
- You should be having sex every other day starting from day 10 till day 16 of your cycle
- Have a blood test on day 21 of the cycle. This test is called Day 21 Progesterone. You will be given the request form for the blood test.
- One week after this test you should telephone my office for the result of your blood test.
- If the result of your blood test shows that you are not ovulating (have not released an egg) then wait for your next period.
- If you did have your period, restart taking Clomid, this time using 100mg (two tablets) instead of 50mg for five days. If you are still not ovulating after taking 100mg of Clomid then repeat, this time taking 150 mg (three tablets) for 5 days.
- If your next period has not arrived within 40 days, take a pregnancy test
- If the pregnancy test is negative and you did not have a period, you may use Provera tablets to start your period
- If your Day 21 Progesterone blood test confirms ovulation, however, you did not fall pregnant, then carry on with the same dose of Clomid for up to 6 cycles.
If periods are infrequent or irregular
- Have a pregnancy test if you have not had a period in the last 40 – 45 days
- If the pregnancy test is negative you can start Provera tablets, 10mg twice daily for five days. This is to stimulate a period so that you can start to take Clomid.
- The bleeding should start five to ten days after the end of taking the Provera
- If you do not bleed, repeat the pregnancy test. If negative, take the Provera tablets again at 10mg twice daily for five days.
- If you still do not bleed then book an appointment to return see me.
Clomid should not be used for more than six cycles in your life due to the slightly increased risk of ovarian cancer if used for more than 12 cycles.
You should ideally take the Clomid at the same time every day, and some say that taking the pill before bed can help you sleep through some of the side effects. Some do better if they take the pill in the morning. If you have another Clomid cycle, you can try taking it at a different time of the day, but don’t change the time of day once you start the cycle.
You won’t ovulate on the five days you’re actually taking Clomid, but with your first dose, Clomid begins a chain reaction that will eventually lead to ovulation.
Ovulation typically occurs 5 – 10 days after taking the last Clomid pill. So if you took Clomid on days 3 to 7 of your cycle, you are most likely to ovulate between days 10 and 16. Ovulation can, however, occur even later than 10 days after your last Clomid pill, so it’s something to keep in mind.
What Are The Signs Clomid Is Working?
When it comes to stimulating ovulation, Clomid is very successful, resulting in the release of mature eggs in roughly 80% of women who use it. However, only about 10% to 13% of those will get pregnant per cycle.
One good sign that Clomid is working is that your basal body temperature falls slightly then rises again. Your cervical mucus becomes clearer and thinner with a more slippery consistency similar to that of egg whites. Your cervix softens and opens up. You may feel a slight twinge of pain or mild cramps in your lower abdomen. Once your discharge becomes scant and sticky again, Clomid has finished working and your ovulation is over.
Clomid does not increase your chances of pregnancy if you have infertility factors that are unrelated to ovulation, such as blocked tubes, uterine abnormalities, ovarian failure, pelvic lesions, certain male infertility factors, etc.
How to Track Clomid Induced Ovulation Using Ovulation Predictor Kits
OTC ovulation predictor kits measure your levels of luteinizing hormone (LH), which can be detected in your urine. These kits work because ovulation typically hits about 10 to 12 hours after LH peaks—on day 14 to 15 of the menstrual cycle if your cycle is 28 days long. Your LH concentration should stay elevated for 14 to 27 hours to allow for full maturation of the egg.
Here’s how the ovulation kit works: Pee on the stick and wait for a line to appear. If the color of the line matches the shade shown on the instructions, ovulation is imminent—within 24 to 48 hours. If it’s too close to call, retest within the next 12 hours. Most kits come with a five-day supply of sticks, to be used in as many days, but check their expiration date: Most of them have a shelf life of only two years. While the majority of ovulation predictor tests can be used any time of day, many of them suggest testing first thing in the morning. For best results, test around the same time each day, and cut back your liquid intake for four hours beforehand, so your pee will be more concentrated and your LH easier to detect.
The real trick to finding success with an ovulation predictor kit is knowing when to start using it. If your cycle is regular, the charting you’ve been doing can help you identify that optimum window. If your cycles are irregular, your best bet is to pay attention to ovulation symptoms. Even if you’ve confirmed that ovulation is happening (through tests or other signs), try to wait to have sex until you notice an increase in cervical mucus, which will heighten the chances of conceiving.
