Active Ingredient: Clomiphene
A clomiphene citrate 50 mg tablet is taken orally for 5 days.
On day 11 or 12 of the menstrual cycle, ultrasound monitoring is conducted to determine if an ovarian follicle or follicles have developed.
Also at this time, patients are asked to use an ovulation predictor kit to test their urine for a surge in LH luteinizing hormone indicating that eggs have matured and ovulation is imminent.
Natural intercourse or insemination is timed to ovulation. If ovulation has been assisted by an hCG injection, a form of the hormone progesterone is given via vaginal tablets or gel. The progesterone hormone serves to support the endometrial uterine lining and prepare it for the fertilized egg.
If the test is positive, a blood test will be performed to confirm results.
If ovulation doesn't occur during this initial clomiphene dosage, another course of provera will be prescribed and the dose of clomiphene increased until ovulation occurs.
This is sometimes referred to as "superovulation. Starting clomiphene early in the cycle helps with the recruitment of more than one mature egg. Typically, two clomiphene citrate 50-mg tablets are taken orally for 5 days, from cycle day 3 to cycle day 7.
The ultrasound helps to determine how many mature eggs are forming within their follicles. In order for ovulation induction to be successful, 2-3 follicles should be visible at this point with just one follicle, we would not be significantly enhancing a woman's chances to become pregnant.
When an ovarian follicle matures, it produces the hormone estrogen, which causes the lining to thicken in preparation for an implanting embryo. Ultrasound monitoring at this stage also serves to measure the endometrial uterine lining and to make sure the clomiphene itself is not having any adverse effects on the endometrium see Clomiphene side effects, At this stage, patients are also asked to use an ovulation predictor kit to test for a surge in LH hormone, indicating imminent ovulation.
We usually recommend up to 6 cycles for ovulation induction patients and up to 3 or 4 for ovulation augmentation patients.
If the lining is too thin, the embryo cannot implant successfully. This side effect tends to occur with repeated use or with higher doses of medication.
Endometrial thinning will stop once clomiphene treatment concludes. An alternative therapy often recommended in these situations is a medication called Letrozole, which has a milder effect on the hormonal system.
Letrozole temporarily lowers estrogen levels, prompting the pituitary gland to increase FSH and LH production and promote ovulation. While letrozole is not yet FDA-approved for ovulation induction, widely conducted studies indicate that there is no detriment to this treatment option.
This condition is rare in clomiphene treatment, and more common with use of gonadotropin medications. Ovarian hyperstimulation syndrome is marked by abdominal bloating, nausea and diarrhea, and in more severe cases, symptoms including shortness of breath, difficulty with urination and chest pain.