Should i start clomid

Your doctor can review your bloodwork to see where in your cycle you are. If you have irregular periods or you don't get a period, your doctor can perform a "random start.

If you have irregular periods , your doctor might prescribe the medication Provera medroxyprogesterone , a form of progesterone. When you take this medication, it will induce a period. Your doctor might want you to take a beta pregnancy test via blood work to ensure you're not pregnant. To make the cycle easier to track, you can mark on a personal calendar the days of your cycle alongside the calendar dates. For example, if you start your period on April 3rd, write a "1" April 3rd, a "2" on April 4th, a "3" on April 5th, and so on.

When you call your doctor on the first day of your cycle, you may be asked to schedule a baseline ultrasound check. This is more likely to be done by a fertility specialist.

The ultrasound appointment is quick and will be done transvaginally. A transvaginal ultrasound is done with an ultrasound probe via your vagina. Your doctor is looking for cysts on the ovaries, not to be confused with the tiny cysts one might see with polycystic ovaries. In this case, the doctor is looking for a larger cyst. Usually, the ultrasound doesn't find anything.

If everything looks good, your cycle can go on as planned. If the ultrasound shows that you have a cyst, your doctor will likely cancel this cycle. You may need to wait until next month to try again. If they do find a cyst, don't worry. These cysts are rarely harmful and will usually disappear on their own. The main downside is you'll have to wait another month to start treatment.

As always, ask your doctor if you are concerned. Once you've been cleared by your doctor, you'll take your first dose of Clomid on the day your doctor has instructed.

You'll take one dose every day for five days, but you won't take any Clomid on the first day of your cycle. Your doctor may tell you to take the Clomid pills on one of the following sequences:.

Some doctors will have you start treatment on cycle day 2 or cycle day 4, though this is less common. There doesn't seem to be a difference in pregnancy success between beginning Clomid on day 3 or day 5. Different doctors prefer to use different protocols. In some cases, your doctor may ask you to change the start day on your next cycle, to see if it'll make a difference for you. Ideally, take the Clomid at the same time every day. Some say that taking the pill before bed can help you sleep through some of the side effects.

Others 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 day, but don't change the time of day once you start the cycle unless you speak to your doctor. You won't ovulate on the five days you're taking Clomid pills. However, with your first dose, Clomid begins a chain reaction that will eventually lead to ovulation. In short, the hormone FSH follicle-stimulating hormone signals the ovaries to grow and mature eggs encased in follicles of fluid to be released via ovulation.

As the follicles on the ovaries grow, they release estrogen. The increase in estrogen signals the brain to slow down the production of FSH. This, in turn, slows down the stimulation of the ovaries. Clomid works by tricking the brain into thinking your estrogen levels are unusually low.

It does this by blocking estrogen from binding to its receptor. So, although estrogen is circulating in your bloodstream, the receptors are unable to detect it.

Thinking there are no growing follicles since estrogen appears to be low, your body responds by releasing more gonadotropin-releasing hormone GnRH. The higher levels of FSH stimulate the ovaries, and the higher levels of LH eventually trigger ovulation.

Even though you take Clomid for only five days, the chain reaction that starts with your first pill continues throughout the month. This is one reason why you may continue to experience some side effects days after you take your last dose. Beyond suggesting that you use an ovulation predictor kit so you can time intercourse for your most fertile days, most gynecologists don't carefully monitor Clomid treatment cycles.

That said, many reproductive endocrinologists do. Fertility doctors monitor Clomid cycles for two primary reasons:. Monitoring the cycle usually starts a few days after your last Clomid pill is taken and may involve ultrasounds and blood work every few days until you ovulate. The ultrasound technician will measure the growing follicles, and your doctor will decide based on their growth when to time a trigger shot if you're having one , an IUI, or intercourse for the cycle.

If two follicles develop to a mature size, your doctor may or may not advise you to skip the cycle. Two large follicles raise your odds for conceiving twins , but it's not guaranteed. Tell your doctor if it's important to you to avoid conceiving twins, so they can better advise you on what to do. If three or more follicles mature, your doctor will likely cancel the cycle, meaning you'll be asked not to have sex to avoid conceiving. And if an IUI or trigger shot was planned, neither will be given to avoid a higher multiple pregnancy, which carries serious risks to you and your future babies.

If your cycle is canceled, as tempting as it may be to ignore your doc and have sex anyway, you should take your doctor's warnings seriously. It may be a good sign that your body reacts to Clomid so sensitively. In some cases, additional vaginal estradiol can help restore the endometrial thickness. Switching to an alternative follicle-stimulating medication might alleviate this side effect.

We frequently see women given low doses of Clomiphene citrate that do not induce the growth of multiple eggs but thin out the endometrial stripe. In such cases, the woman is actually worse off than in a natural menstrual cycle. She did not gain any additional eggs and has only thinned out the endometrial lining. Patients not monitored with an ultrasound might be unaware of this side effect.

Therefore, every serious fertility expert will always perform a transvaginal ultrasound in a Clomid cycle. We always want to document how many follicles developed and the endometrial thickness. Common Clomid side effects include hot flashes, headache, blurry vision, mood swings, and can induce a change in cervical mucus. Clomiphene works directly on the pituitary gland and also affects many tissues with estrogen receptors. This is in contrast to injectable gonadotropins like Gonal-F that targets primarily just the ovary.

Therefore many patients will notice changes in their body during the Clomid cycle. Fortunately, none of these is a long-lasting side effect, and there are no long-term effects. While some concern was raised regarding ovarian cancer, there is no conclusive evidence that considerate use of Clomifen increases the risk.

Rarely, a patient can develop ovarian hyperstimulation syndrome OHSS. Such a condition needs immediate medical attention and is considered a severe side effect. Usually, these patients have high AMH levels. Another side effect is ovarian cysts that can occur weeks after treatment! The cysts are often discovered once we see the patient for another treatment cycle start or in cases of pelvic pain.

The reason behind this is that Clomiphene may remain active in the woman's body for several weeks. The ovaries may continue to stimulate, increasing the occurrence of ovarian cysts.

We sometimes see extreme responses , and we have had patients develop too many eggs - as high seven or eight eggs! Some patients develop the hyperstimulation syndrome and ovarian enlargement and need immediate care by a fertility specialist. While higher-order multiples are rare, patients have conceived triplets using Clomifene alone. Fortunately, the majority of patients develop follicles with the right dose.

Some patients with very severe PCOS show resistance to the medication. While very useful in patients who do not ovulate eggs, some patients show no response because their condition is too severe. Another frequently used term is " Clomid resistant. In such cases, we need to use injectable gonadotropins like Gonal-F or Follistim to restore the ovulatory cycle.

A woman can start taking Clomid tablets between cycle day three and cycle day 5. Each tablet contains 50mg of Clomiphene Citrate. Typically patients take tablets daily for a total of five days. The medication remains effective in the body even after all tablets are consumed since the half-life is very long.

In some cases, when used as an adjunct to mini-IVF, it can be given over an extended period of time. This makes Clomid a more palatable first-choice fertility drug because injectable medications are more involved and can have more intense or serious side-effects.

It is also a preferred choice for women who have PCOS since the dosage can be closely monitored, minimizing the chances of high order multiples triplets or higher. Clomid blocks estrogen production, and this stimulates your hypothalamus and pituitary glands to produce gonadotropin-releasing hormone GnRH , follicle stimulating hormone FSH and luteinizing hormone LH.

The presence of these hormones catalyzes the maturation of the egg follicles, increasing the chances of ovulation. Thus, Clomid is not an infertility treatment cure-all. 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.

One of the reasons doctors and their patients prefer Clomid is that it has reasonable success rates and minimal low-risk side effects. Those who do have side effects report bloating, nausea or headaches. Blurred vision and hot flashes have also been reported.