so what is the typical procedure with clomid? What are all the things that should be done while on it?
Taken from Trouble TTC page - new here link
Clomid blocks the effects of estrogen in the brain (specifically at the pituitary), which leads to increased levels of two hormones: LH and FSH. Higher LH and FSH stimulate follicle development in the ovary.
There are several types of patients who are prescribed Clomid:
1. Anovulatory cycles (typically PCOS)
2. Luteal phase defect
3. Unexplained infertility
Before starting Clomid, you should have a full work-up for infertility to ensure Clomid is the appropriate medication. You should discuss this work up with your physician, but it will typically include:
1. Semen analysis to make sure there aren’t any problems there. (What good is ovulation induction if there’s a sperm problem?)
2. HSG, especially if over age 35 to avoid using ineffective treatment when fertility is in decline
3. Day 3 labs, especially FSH since Clomid is less effective in women with high FSH
Your doctor may want to run other tests as well. Once it has been determined that Clomid is an appropriate treatment, it is typically started at a dose of 50 mg per day for 5 days (usually days 3-7 or 5-9). If ovulation is not achieved on this dose, it can be increased to 100 mg, then 150 mg. Your doctor may choose to use different doses depending on your particular case of IF.
Your LH surge will typically occur 5 days after the last dose of Clomid. Depending on your treatment plan, you will want to start using OPK’s 5 days after the last pill. Clomid can cause a false positive OPK if you check too soon, since Clomid artificially increases LH levels, which is what OPK’s measure. Most doctors don’t recommend using Clomid for more than 6 cycles.
Most of us are monitored with our RE’s when on Clomid. This means we get baseline ultrasounds to ensure there are no cysts (you don’t want to stimulate the ovary if you have cysts) and we get mid cycle ultrasounds to monitor response. Not all doctors do ultrasound monitoring because you can often determine whether you are ovulating with a 7 day post-ovulation blood progesterone level, and the risks of Clomid are low. However, the risks are real and it is important that you know what they are. Your physician may be comfortable not doing monitoring, but you need to be comfortable with this decision as well.
The mid-cycle ultrasound is probably the most important. It can tell you some very important information. First, it will determine whether you are responding to the Clomid. If there are no follicles, your doctor can adjust your treatment plan appropriately, and you don’t waste time taking a medication that doesn’t work for you. Second, it can determine if you are responding *too* well to the Clomid. The risk of multiples is higher with Clomid, and while most of that risk is for twins (7-9%), the risks of triplets (1 in 200 pregnancies), quads (1 in 300), and quintuplets (1 in 800) are also increased. If you don’t know how many follies you have, you can’t know your risk of multiples.
Rarely, people will have more serious side effects. While these are very rare, they do happen and you should know this when you agree to take Clomid without ultrasound monitoring.
If you read the information sheet that comes with the prescription, you will find that all of those side effects have been experienced by someone on this board. Most common is hot flashes and night sweats. Other common complaints are bloating, mood swings and headaches. Some people find the side effects are easier to tolerate if they take Clomid at night. Some people don’t notice any side effects from the Clomid.
In addition to the common side effects, Clomid can thin the endometrial lining, making it difficult (if not impossible) for implantation and pregnancy to occur. Mid-cycle ultrasound monitoring will show whether your lining is being affected by the Clomid, and your doctor can change your treatment plan accordingly. You also have higher risk for multiples, but mid-cycle ultrasound can show if there are more than 3 follicles, and you can discuss with your physician whether you are comfortable moving forward in that situation.
For every 100 women treated with Clomid, 70 will ovulate and about 25 will have a successful pregnancy. The efficacy will depend on your diagnosis.