Ultrasound picture of a polycystic ovary
Many small, immature follicles (black circles) are seen
Normal ovary with a mature follicle (at cursors)
18mm diameter follicle is about ready for ovulation
PCOS and Clomid Treatment – Ovulation and Pregnancy Success Rates
Can I conceive with PCOS?
The chance for pregnancy with fertility treatments for PCOS is very good. The great majority of women with polycystic ovarian syndrome will be able to have a baby with treatment.
For women under age 35, the question is more about which PCOS treatment will work – and not so much about whether any treatment will work.
Ovulation Success Rates
Women with PCOS will often ovulate after taking Clomid. However, this is variable and some will not respond to Clomid at all
About three fourths of women that are not ovulating will ovulate on Clomid at some dosing level
Women under 35 with PCOS should have about a 15% chance for pregnancy per month with Clomid treatment (for about 3-4 months) – if they ovulate with Clomid (if sperm and fallopian tubes are normal).
Clomid for PCOS – Pregnancy Success Rates
Only about 50% of women that ovulate with Clomid get pregnant with it
For women with PCOS under age 35 in our in vitro fertilization program the success rate is about 70% for pregnancy with one IVF cycle, and about 60% for live birth (miscarriages account for the different rates).
In order to induce a period, Provera is given for 5 to 10 days at a dose of 5 or 10mg daily
The period usually starts within 2-7 days after the last Provera pill is taken
Starting Clomid
Clomid is started early in the menstrual cycle and is taken for five days either from cycle days 3 through 7, or from day 5 through 9
Clomid is usually started at a dose of one tablet (50mg) daily – taken any time of day
Increasing Clomid Dosage (if needed)
If the patient does not ovulate on the starting dose, Provera is often given to induce a period – then a 100mg dose of Clomid is tried
If she does not ovulate on a 100 mg dose, then 150mg is sometimes tried
Clomid Dosing Recommendations
Clomid works best when the lowest dose that results in ovulation is used
If a woman ovulates on 50mg then increasing to 100mg is probably of no benefit – and may result in increased side effects
Many women will ovulate on 50 or 100mg, and some will require 150 mg in order to get an ovulatory response
Some pregnancies will occur on clomiphene doses above 100mg. However, increasing the Clomid dose to 200mg results in very few additional pregnancies.
How long does it take to ovulate using Clomid?
For women that do not ovulate on their own, the average day that ovulation occurs is about 8 to 10 days after completing a 5 day course of Clomid.
That means that a woman taking Clomid on days 5-9 will often ovulate on about day 16-20 of the cycle
However, there is significant variation in how long it takes ovulate using Clomid. Some will ovulate much later – as late as two or three weeks after the last clomiphene tablet.
How long should I try Clomid before moving on to other treatment options?
There is no set number of cycles of Clomid that should be done before moving on to other fertility treatments. Several variables are involved in the decision about moving on to more aggressive therapy.
No Ovulation Results After increasing Clomid Dosage
If a woman is not ovulating on a low dose of Clomid, the dose should be increased
If not ovulating at 150 mg then other therapies should be attempted
Female age and Clomid treatment and when to be more aggressive
Relatively fewer cycles should be done with an older female partner
Clomid probably should not be used at all if the female age is 40 or older because of the significantly reduced fertility potential
Women 38 or older should probably start fertility treatment with a fertility specialist – rather than with their gynecologist
If the female is under 38 years old and the sperm is good then usually 3-6 months of Clomid cycles (with good ovulation) are often tried
Personal factors regarding Clomid treatment and when to be more aggressive
The patient’s own sense of urgency
Other personal factors, including degree of severity of any Clomid side effects
Financial considerations
Clomid and Treatment Costs
Clomid is not expensive and costs 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 the Clomid pills for a cycle is about $40
The average cost for generic clomiphene citrate is about $15
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