How does a Clomid cycle work?
Clomid® (clomiphene) is a pill that helps women ovulate. It can also cause the ovulation of multiple eggs in one month. It is the first line of fertility treatment for many women. Women who do not ovulate (have irregular periods) are the ideal candidates for a Clomid cycle.
If you decide to take Clomid®, you will be asked to call our office on the first day of your period.
You will then be scheduled for a “baseline ultrasound” to be performed anytime between cycle days 2 and 5. This ultrasound is done to make sure that you do not have any cysts in your ovaries, as cysts take up room in the ovaries that is necessary for the development of ovarian follicles. If no cyst is seen on the ultrasound, a clomiphene prescription is given for five days, usually starting cycle day 3, 4, or 5.
You will then be scheduled to return to Texas Fertility Center-San Antonio for another ultrasound that will be performed typically 5 days after your last Clomid® pill. This ultrasound will determine how you are responding to the dose of clomiphene that you are taking. During this “midcycle ultrasound”, Dr. Munch or Dr. Hudson will measure the size and number of the follicles in the ovaries and they will also measure the thickness of your endometrial lining, as clomiphene can cause thinning of the uterine lining in some women rather than thickening. If your lining thins during clomiphene treatment, Dr. Munch or Dr. Hudson will recommend an alternative fertility medication. During this sonogram, you should have a follicle that is measuring at least 14-15 mm. If this is the case, then you will be asked to start using a urinary ovulation prediction kit every morning. This kit detects the presence of luteinizing hormone (LH), the hormone that triggers ovulation to occur. Most women will ovulate between 6-9 days after their last clomiphene pill. If you not have an LH surge around this time, then your physician may prescribe a medication called Ovidrel® for you to take. This injectable medication takes the place of the LH surge and causes ovulation of the egg. We will then either schedule an intrauterine insemination (IUI), or ask you to start having intercourse every other day, based on when ovulation should occur.
Clomid cycle: baseline scan, clomid pills, midcycle scan, LH surger or ovulation trigger and intercourse or IUI.
During the midcycle ultrasound, if no large follicles are seen, then no eggs are responding to that dose of clomiphene. Depending on the thickness of your uterine lining, we will either give you 10 days of progesterone pills to make you have a period so we can start over or – if your lining is thin – we will immediately ask you to take the next higher dose of clomiphene for five days followed by another “midcycle” ultrasound five days later. This plan will be repeated until follicle development occurs or the maximum dose of clomiphene is reached. If no response occurs to the maximum dose, then a different fertility medication will be prescribed.
A blood pregnancy test will be ordered two weeks after ovulation.
We will call you with the result of this test, and if you are pregnant, further blood tests will be ordered. Either Dr. Munch or Dr. Hudson will do an ultrasound at around 6 ½ – 7 weeks’ gestation in order to make sure that the baby is growing appropriately within the uterus and to confirm the presence of a normal fetal heartbeat. If the pregnancy test is negative, then clomiphene can be attempted again when your period starts. If you have not successfully conceived after three-six cycles of clomiphene, Dr. Munch or Dr. Hudson will most likely recommend a change in approach.
Our team at Texas Fertility Center – San Antonio is committed to performing a thorough fertility evaluation and starting you on appropriate treatment as soon as possible so that you can achieve your dream of having a family. Contact us today.