Women who do not ovulate without medications are said to be anovulatory and have a condition called anovulation
Many of these women have polycystic ovarian syndrome, or PCOS
Clomid is also frequently used to stimulate extra follicles to develop in the ovaries of women that already ovulate without medications
In these cases the hope is that increasing the number of eggs releasing will increase the chances for getting pregnant

How does Clomid work?

Clomid works as an “anti-estrogen” that tricks the brain into thinking that estrogen levels in the body are very low. It does this by binding to estrogen receptors in the brain and blocking the ability of estrogen to bind to those receptors.

The brain then thinks that estrogen levels are very low so it releases GnRH hormone which goes to the pituitary gland and stimulates release of follicle stimulating hormone (FSH). The job of FSH is to stimulate development of a mature follicle (egg containing structure) in the ovary.

Women that do not ovulate regularly, such as those with PCOS, will often ovulate after taking Clomid. However, this is quite variable and many anovulatory women will not respond to Clomid and ovulate at all.

In general, about three fourths of women that are not ovulating “on their own” will ovulate on Clomid at some dosing level
Unfortunately, only about half of the women that ovulate with Clomid will get pregnant with it

How long does it take to ovulate using Clomid?

On the average ovulation occurs about 7-10 days after completing a course of Clomid pills. This varies quite a bit, depending on whether the woman ovulates regularly on her own or not.

Some women will ovulate before seven days after the last Clomid tablet and some that have very irregular cycles will ovulate much later – as late as two or three weeks after the last clomiphene tablet.

Timing intercourse after Clomid treatment

There is no perfect “ovulation calculator” to use with Clomid. It is best to have intercourse on the day of ovulation possible. The trick is to figure out what day that is.

Some women use ovulation predictor kits with Clomid cycles to time their sex
These kits are available at drugstores and supermarkets and are are urine tests that the woman does at home
These ovulation predictor kits, also referred to as OPKs, are designed to detect the presence of the woman’s LH surge
The LH surge in the bloodstream begins approximately 36 hours prior to ovulation
The ovulation prediction kit test is usually done once daily and when it turns positive then sex either the same day or the next morning are the best for fertility.

Couples often ask “when should we have intercourse, and how often” in order to get pregnant.?

Sex once on the day of ovulation should be good enough
However if the ovulation day is not certain, then intercourse every other day (or every day) around the time of ovulation is a good option
If sperm is normal it should live in the reproductive tract of the female for 3 to 5 days
However, the egg has a life span of only 12 to 24 hours. Therefore, intercourse a day or two before ovulation should be fine, but if the first recent sex is more than 24 hours after ovulation then the egg has already degenerated.

Ovulation generally occurs about 14 days prior to the onset of the next menstrual period. Therefore, when the menstrual cycle length is known for the woman's typical Clomid cycle, then intercourse can be timed to fall about 12 to 16 days prior to the “expected” date for the next period.

For example, if the woman has a 32 day cycle length on Clomid, then she is probably ovulating on about day 18. A good plan for having intercourse would be to have sex on about days 16, 18 and 20.

Monitored Clomid cycles using follicle ultrasound scans and blood hormone levels

Infertility specialists and some gynecologists will monitor the development of follicles with “follicle checks” by ultrasound scans
This is done with or without monitoring blood hormones during clomiphene treatment cycles
This approach allows clarification of the level of response and is a good way to determine proper timing for sex or intrauterine insemination, IUI
Usually when Clomid cycles are monitored an HCG trigger injection will be given to the woman when the growing follicle(s) is at a mature size
The HCG trigger injection acts in the body just like an LH surge would – and ovulation should occur about 36 to 40 hours after the shot is given

When follicle scans are used with Clomid along with an HCG injection, the ideal follicle size for getting mature eggs is about 18 to 30 mm diameter at the time of the hCG injection.
Ultrasound and blood testing during Clomid cycles will also show us when no mature follicles are developing in response to the medication. In those cases we know that we will need to try a higher dose of Clomid, or move on to another form of therapy.

Clomid and injectable gonadotropins

Sometimes clomiphene is used in conjunction with injectable gonadotropins (“injectables”), particularly when the woman is not responding and ovulating well to Clomid alone.
Injectable gonadotropins contain FSH hormone – we boost the FSH level in the blood by injecting FSH
There are several protocols for adding the injectables in a Clomid cycle
It is important to monitor follicle development carefully with ultrasound scans and blood hormone levels when injectable FSH products are used
This is because using Follistim, Gonal-F, Menopur, or Bravelle (injectable FSH brand names) with Clomid can greatly increase the number of developing follicles

One example of a monitored Clomid + injectable protocol is shown here:

Clomiphene pills taken days 3 to 7
Start injectable FSH product (Follistim, Gonal-F, Bravelle, Menopur) on day 10 at a dose of 75 units per day
Monitor response with estradiol and LH blood levels and ultrasound follicle scans starting on day 13
Repeat monitoring visits as indicated by the egg production response in the ovaries
Trigger ovulation with 10,000 units of HCG when 1 – 2 follicles measure 17 to 19mm diameter
It is very important to avoid stimulation of too many mature (or close to mature) follicles because of the risks of multiple pregnancies – including twins, triplets and higher.

Clomid and artificial insemination, IUI

Infertility specialist clinics will often add intrauterine insemination to clomiphene cycles in order to increase the chance for pregnancy. Insemination is particularly beneficial for women that already ovulate on their own and have unexplained infertility or a male factor situation.

IUI success rates

Clomid and twins and higher order multiple pregnancies

What is the percentage of conceiving multiples on Clomid? One large study of Clomid use showed that pregnancies were:

92% singletons
7% twins
0.5% triplets
Very rarely higher than triplets

Costs of Clomid medication and Clomid treatment cycles

Clomid is not expensive and will cost between about $10 and $100 per cycle depending on the dose and whether a brand name or generic clomiphene citrate is used.

The average cost for Clomid for a cycle is about $40
The average cost for generic clomiphene citrate is about $15
Approximate average costs in the US (and costs at our clinic) for fertility treatment costs

Fertility Medications

Ovulation Treatment

Clomid Fertility Drug Treatment

Femara-Letrozole

Metformin (Glucophage)

PCOS and Clomid Fertility Treatment