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.
Some important variables are:
Female age is an issue. Relatively fewer cycles should be done with an older female partner. Clomid probably should not be used at all if the female is 40 or older because of the significantly reduced fertility potential.
If the female is under 38 years old and the sperm is good, 3 months of clomiphene cycles (with good ovulation) are often tried.
The patient's own sense of urgency, financial considerations and other personal factors will often be part of their decision about when to move on to other fertility options.
Clomid is usually started at a dose of one tablet (50mg) daily - taken any time of day.
If you do not ovulate on the starting dose,then a 100mg dose of Clomid is tried.
If you do not ovulate on a 100 mg dose, then 150mg is sometimes tried.
Infertility specialists and some gynecologists will monitor the development of follicles with "follicle checks" by ultrasound scans 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 the proper timing for sex or intrauterine insemination. Usually when Clomid cycles are monitored an HCG trigger injection will be given to the female 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 would be expected to occur approximately 36 to 40 hours after the injection.
When follicle scans are used with Clomid along with an HCG injection, the ideal follicle size for getting mature eggs is about 20 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.
Sometimes clomiphene is used in conjunction with injectable gonadotropins, particularly when the female is not responding and ovulating well with Clomid alone. Injectable gonadotropins contain FSH hormone. Therefore we can boost the FSH level in the blood by adding the injectable FSH product. There are several protocols for adding the injectables in a Clomid cycle. It is important to monitor follicle development 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 follicle number. 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 one or two follicles are measuring about 17 to 19mm in 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.
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 are using the Clomid to get extra egg production.