PCOS and Clomid Fertility Treatment

Establishing “Day One” of the Menstrual Period

• Day one is counted as the first day of menstrual bleeding.
• The period can be from a spontaneous menstrual period or from a period induced with a progestin medication such as Provera (medroxyprogesterone acetate).

Inducing a Period (if needed)

• In order to induce a period, Provera is given for 5 to 10 days at a dose of 5 or 10mg daily.
• The period usually starts within 2-7 days after the last Provera pill is taken.

Starting Clomid

• Clomid is started early in the menstrual cycle and is taken for five days either from cycle days 3 through 7, or from day 5 through 9.
• Clomid is usually started at a dose of one tablet (50mg) daily - taken any time of day.

Increasing Clomid Dosage (if needed)

• If the patient does not ovulate on the starting dose, Provera is often given to induce a period - then a 100mg dose of Clomid is tried.
• If she does not ovulate on a 100 mg dose, then 150mg is sometimes tried.

Clomid Dosing Recommendations

Clomid works best when the lowest dose that results in ovulation is used:

• If a woman ovulates on 50mg then increasing to 100mg is probably of no benefit - and may result in increased side effects.
• Many women will ovulate on 50 or 100mg, and some will require 150 mg in order to get an ovulatory response.
• Some pregnancies will occur on clomiphene doses above 100mg. However, increasing the Clomid dose to 200mg results in very few additional pregnancies.

For women that do not ovulate on their own, the average day that ovulation occurs is about 8 to 10 days after completing a 5 day course of Clomid.

• That means that a woman taking Clomid on days 5-9 will often ovulate on about day 16-20 of the cycle.
• However, there is significant variation in how long it takes ovulate using Clomid. Some will ovulate much later - as late as two or three weeks after the last clomiphene tablet.

There is no set number of cycles of Clomid that should be done before moving on to other fertility treatments.

Several variables are involved in the decision about moving on to more aggressive therapy. No Ovulation Results After increasing Clomid Dosage

• If a woman is not ovulating on a low dose of Clomid, the dose should be increased
• If not ovulating at 150 mg then other therapies should be attempted

Female age and Clomid treatment and when to be more aggressive Relatively fewer cycles should be done with an older female partner Clomid probably should not be used at all if the female age is 40 or older because of the significantly reduced fertility potential Women 38 or older should probably start fertility treatment with a fertility specialist – rather than with their gynecologist If the female is under 38 years old and the sperm is good then usually 3-6 months of Clomid cycles (with good ovulation) are often tried Personal factors regarding Clomid treatment and when to be more aggressive The patient’s own sense of urgency Other personal factors, including degree of severity of any Clomid side effects.