How Should Clomid Be Taken?
Clomid is available as a 50 mg tablet for oral administration. It is typically prescribed for one five-day cycle each month. Users begin taking Clomid three to five days into a menstrual cycle. A patient who is not menstruating at all will either be instructed to start taking Clomid at any time or she will have her period chemically induced with a drug like Provera (medroxyprogesterone acetate).
Often while on Clomid, a woman’s ovaries are monitored to see if the release of an egg is imminent. If a woman is unsure when ovulation takes place, she may be instructed to use an ovulation prediction test kit that identifies a surge in luteinizing hormone, indicating ovulation is near. As the best time to conceive is one to two days before ovulation, it is recommended that couples engage in sexual intercourse every day or every other day in the days preceding ovulation. It can take several cycles for Clomid to work effectively.
There are other methods for monitoring ovulation, in addition to an ovulation prediction kit, that may be suggested for use concomitant with Clomid therapy:
noting ovulation pain (mittelschmerz)
monitoring cervical mucus changes
blood progesterone test
ovarian ultrasound examination
Sometimes Clomid may be combined with other drugs to improve chances for ovulating and conceiving. Metformin, an insulin sensitizer, is sometimes prescribed concomitantly with Clomid to increase its efficacy, especially in PCOS patients who are overweight or obese (see Precautions, below).
How Does Clomid Work?
Clomid works by stimulating the pituitary gland to produce more FSH (follicle-stimulating hormone). This, in turn, stimulates follicle (egg) growth in the ovaries, causing them to produce one or more mature eggs.
What Is the Success Rate of Clomid?
Clomid successfully stimulates the ovaries about 80% of the time it is used. Roughly 40-45% of women become pregnant within six cycles of taking Clomid. These statistics are the same for women with anovulation, oligoovulation, and luteal-phase deficiency.
Women with PCOS (polycystic ovary syndrome) who take Clomid and metformin together (see Precautions, below) have a reduced success rate of pregnancy (7.2%-22.5%).
If a woman does not conceive after six cycles, most physicians usually look at other treatment options. The dose can be increased from 50 mg to 250 mg in 50 mg increments, although at higher doses the chances of conception can actually be lower. In many cases, the side effects above 150 mg cause discontinuation of the drug. Usually the drug dose will be increased after the first few cycles if ovulation is not successful; few physicians maintain a patient at the starting dose for the full six months if ovulation does not occur. Successful ovulation without conception after six months is cause for consideration of other infertility factors.