"My doctor prescribed Clomid® and told
me how to use it but I don't get my period every month.
I have some birth control pills left. Should I use
them so I can start the Clomid®?". K.
I feel very badly that you did not get instructions
on how to take the Clomid®(clomiphene citrate).
This reflects poorly on the medical profession because
induction of ovarian ovulation can be somewhat complicated.
You actually need detailed instructions depending
upon what condition you have and which regimen the
doctor likes to use.
Do I need to have a menstrual period induced before
taking clomiphene?
In theory no, but in practice yes. If you knew for
sure you had not ovulated and become very early pregnant,
then inducing a menses would not be necessary. The
reason most doctors give you progestins or progesterone
to induce a menses is to make sure you have not recently
ovulated or become pregnant. If you just ovulated,
the progestins will usually not induce a menses until
14 days after ovulation. This protects you from inducing
an ovulation on top of an ovulation or disrupting
an ovulation and potential pregnancy with unneeded
clomiphene.
Another reason to induce a menses before Clomid®
is to make sure the lining of the uterus is at the
right phase for egg implantation. If a menses is induced,
then the endometrial lining has had only 14 days of
growth and stimulation at the time of ovulation. When
no menses is induced, the endometrium has been growing
and been stimulated for 30 or more days and may not
be as receptive to egg implantation.
Finally, if a menses is induced, the doctor knows
for sure that you are not pregnant. Even if you use
the most sensitive home pregnancy test you could still
be pregnant with a negative test. Thus having a menstrual
period is good reassurance that you are not pregnant
and that the lining of the uterus is best prepared
for an ovulation and potential pregnancy.
Birth control pills can be used instead of the progestins
if that is all you have. They would be taken for 5
days, one each day, just as you would take progestins
orally (e.g., Provera®). The menses may start
anywhere from 2 days to about 2 weeks after finishing
the progestins or birth control pills.
After my period, when do I take the clomiphene?
The most common regimen is to take the clomiphene
starting on day 5 after the start of menses for 5
days ending on day 9. Another regimen is to start
on day 4 through 8 and a recent publication even indicates
the Clomid® can be taken on day 1 through day
5 (1) with a very successful pregnancy rate. If your
doctor does not indicate otherwise, taking the medicine
on days 5-9 is the usual and most commonly tested
regimen.
Sometimes a 3 day regimen can also be used although
it is not quite as successful at inducing ovulation,
it may have a slightly higher pregnancy rate since
the anti-estrogen effects of Clomid® on the endometrium
are less pronounced (2).
What should I expect or look for after taking
Clomid®?
Most women do not have any symptoms from taking Clomid®.
Some will have some lower abdominal cramps in the
2nd half of the cycle. Rarely (less than 1-2%) a woman
may experience ovarian hyperstimulation syndrome.
In this case the ovaries become quite enlarged and
multicystic. They can cause moderate pelvic pain.
There can also be large amounts of fluid secreted
into the abdominal cavity (ascites). Sometimes the
fluid can be so severe that it can cause heart or
kidney failure.
If you have any pelvic pain or discomfort other than
a few mild cramps, you should let your doctor know
in case you may need an exam.
As far as the efficacy of clomiphene in inducing
ovulation, its success depends upon the underlying
cause of why you do not ovulate. If you have polycystic
ovarian syndrome it is more sucessful than if the
cause of ovulation is hypothalamic anovulation.
When can I check to see if I got pregnant
using the Clomid®?
First it is best to check if you ovulate using the
Clomid®. Most women do this by monitoring their
basal body temperature. This basal (morning) temperature
goes up by about 0.5 degrees F or more (BBT graph)
and stays up during the luteal phase. Ovulation may
occur anywhere from day 12 of the cycle up to day
18 of the cycle or occasionally later using Clomid®.
If the temperature stays up for 17 days or more after
ovulation, then you should run a pregnancy test. If
it is positive, let your doctor know.
There can be a slightly higher early pregnancy loss
rate with clomiphene induced ovulation (3) so if you
have trouble interpreting your basal body temperature
and pregnancy test results, be sure to contact your
physician.
What happens if I do not get pregnant this
cycle?
If you ovulated and the pregnancy test is negative,
then you should take another course of progestins
and start over with ovulation induction at the same
dose. If you did not ovulate, you will need instructions
from your doctor as to whether to increase the Clomid®
dose. Often the dose is increased from 50 mg to 100
mg, to 150 mg and then to 200 mg and at most 250 mg
if no ovulation occurs at the lower doses. Do not
increase the dose on your own without instructions
from your physician.
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