Oral Ovulation Medications for Infertility
What is Clomid?
Clomid (or Letrozole) are orally administered medications which are used to stimulate the ovaries to help achieve pregnancy.
Reasons to use this treatment:
To induce ovulation in a woman who doesn’t routinely ovulate on her own
To enhance fertility in a woman who is having trouble conceiving despite regularly ovulating on her own
To help time ovulation with sperm insemination therapy when indicated
Take the first step
The effectiveness of this therapy depends on many factors, such as the age of the woman, the condition of her fallopian tubes, and the quantity of her partner’s sperm. In general, the average pregnancy rate is 10–20% per try. Not all women will ovulate with this treatment and not all those that ovulate will conceive. Usually 3 cycles constitutes a sufficient try with this therapy, but in some situations we will allow up to 6 cycles.
Side Effects of Clomid
Side effects can occur with this medicine up to 10% of the time. They are usually mild and never life-threatening. The most common side effect is hot flashes which can last up to 10 days. Moodiness, nausea, headaches, and breast tenderness can also occur. Abdominal bloating/discomfort is often experienced as the ovaries grow. If you develop visual blurring or spots/flashes before your eyes, call us as you may need to discontinue the therapy in that case. The incidence of twins (7%) from the use of Oral Ovulation Medication is greater than in the general pregnant population (2%). The chance for triplets or beyond is EXTREMELY rare. The use of Clomid or Letrozole for more than 11 cycles in a woman’s lifetime is generally discouraged because such prolonged exposure has been linked in one study to a higher risk of borderline ovarian tumors in future years.
Directions for Use
• Our office will tell you what dose of Clomid or Letrozole to take. Take the dose every day for 5 straight days. If your dose is more than one pill per day, take them together once a day. Begin the pills on the 3rd day of your cycle (though if you have missed that “start day,” you can begin them as late as day 5 of the cycle ). We count the first day of full flow (not just spotting) as “day one.” If your period seems odd, do a home pregnancy test or call our office be fore starting the Clomid.
• Contact our office on the first (1st) day of your cycle to set up an ultrasound on day 2 to 5 to visualize the ovaries and obtain a blood draw for Estradiol and FSH. You will then be instructed to begin Clomid/Letrozole and an appointment will be set up for an ultrasound in our office to visualize the ovarian follicle(s). This is usually around day 12 or 13 of your cycle (See diagram on back). The ultrasound allows us to confirm that an egg-containing follicle has matured to full size and to see how many eggs might be released. Sometimes a second ultrasound visit is needed a few days later if the follicle is not yet full size. A blood draw is usually necessary at each ultrasound visit to confirm follicle readiness by checking estradiol and LH levels. In the case of women who don’t ovulate reliably prior to the treatment, approx. 80% will ovulate if taking up to 3 pills per day. If there are no follicles larger than 10 mm at the first ultrasound (day 11-14), then we might have you initiate another 5-day course of Clomid or Letrozole at a higher dose right away without waiting for a period. In that case a repeat ultrasound will then be done one week later.
• We usually recommend that a single shot of Ovidrel (HCG) be administered when a follicle reaches mature size. This increases the likelihood of a good ovulation. It also helps pinpoint the optimal day for sexual intercourse or for the insemination.
• Regardless of whether an insemination is planned, we recommend for most couples that they have sexual intercourse every 2-3 days beginning by cycle day 10.
• Approximately one week after ovulation, you will need to get a blood test drawn at one of our offices or at your local blood-drawing station to check your progesterone level. This helps us assess the quality of your ovulation and determines if you need to change your dose in a future cycle. If you do not get a period by 16 days after your expected day of ovulation then you should call us to schedule a blood pregnancy test and progesterone level. You may, in addition, do a home pregnancy test for a rapid result.
• If you are not pregnant after 3 cycles we usually recommend that you make an appointment for another consultation in our office to discuss other treatment options available to you.
The specialists at South Jersey Fertility Center are highly experienced at helping patients achieve their dream of building a family. We serve patients in New Jersey and Pennsylvania with offices located in Marlton, Burlington, Sewell, and Egg Harbor Township. We are easily accessible to patients in Burlington, Mercer, Atlantic, Camden, Ocean and Bucks Counties.