I wanted to start a fresh thread to get more general info about Clomid. I have heard a lot of different things and read a lot of conflicting info on the Internet about it. For instance, what cycle days should it be taken (3-7, 5-9)? What tests, labs, etc. did you have before starting clomid? About when do you/should you ovulate after a cycle of Clomid? How long after a cycle of clomid will one start menstruating (if you are not pregnant)? And is there really that big of an increased chance of twinning on Clomid (I have seen 5-15% increases)?
Thanks!

I just like to add that anyone who has a family history of breast or ovarian cancer may want to make sure they mention this before starting ANY treatments.

Mrssd. I read a lot of journal articles on ovulation induction when I was taking clomid. If you have access to PubMed or a similar database I would look there, search under 'clomiphene.'

Start day: I couldn't find any studies that showed one substantially over the other. I think most doctors in my area seem to prefer 5-9. Mine certainly did, although I took it 3-7 because I wanted to finish the pills before my exams in case of side effects. Regardless, I couldn't find a strong argument for or against either start date. Some docs go with 4-8, still others start on day 2. If you look on different message boards there are a lot of people saying that "Day 3 start is for this" or that "Day 5" is better/worse. I almost went crazy trying to make sense of it. Thats why I went on PubMed and the medical journals and didn't find anything that persuaded me either way.

When will you ovulate? I think accepted wisdom is 5-10 or 5-14 days after your last pill. Again, I couldn't find much info out there. My OB recommended starting urine OPK's a few days after the last pill to look for the LH surge that precedes ovulation. Be careful with this one, though. Sometimes if you have PCOS or on clomid, you can have a basal level of LH that is detected by the OPK's. A lot of women seem to have luck with a cd14 scan at their docs or by charting. To compare: the opk's can predict ovulation a day or so in advance. Only charting or bloodwork can really confirm ovulation, but that happens after the fact and doesn't help you time intercourse.

Twin rates: I believe you should be able to find this on PubMed as well. I think it increase the risk from 5% (normal, non-fertility drug conception) to about 10% with clomid. If you go to injectables, the risk increases again. My OB claims that the risk with clomid is most frequently with twins, very rarely triplets or higher. I remember seeing some studies that seemed to substantiate that.

When should you get your period? About two weeks after you ovulate. This is the luteal phase, and it can vary in different women. "14 days" is the stock answer, but again, I couldn't find data that seemed to corroborate that. Also, despite using ovulation predictor kits, charting, etc... I still was unable to pinpoint ovulation and therefore had no clue when to expect my period. A good argument for being monitored by your doc!

Other questions that I had:

When and how often should we have sex? I found a study showing that conception most often takes play the day before ovulation or two days before. Sex within five days before and and including the day OF ovulation have been known to produce pregnancies. How often? Couldn't find many big studies on this one. A lot of books, my OB and some other sources seem to think that for the average couple, having sex every other day after the last pill and continuing for two weeks would be sufficient. Of course, if you have known male factor issues, this could change. If you have been ovulating regularly and not getting pg, I think most docs would order a sperm analysis.

Is there a "way" we should have sex? A lot of internet info will give you a whole scoop on this. I couldn't find any compelling info so we just did what was comfortable.

Let me know if you have any more questions. Again, all of my info is from my doc, docs I've talked to, PubMed or other databases of journals. I'm not a doc, and only have my experience to draw from. I just know how much info, and mis-info there is out there and how confused I was.

To put it this way: My OB said to me "Not ovulating is your biggest problem. Take the clomid starting on day 5, then have sex every other day after the last pill for two weeks. Wait two weeks more and take a pg test. All the other stuff is just extra."

Also check out Taking Charge of Your Fertility, a great book I got at the library for all kinds of cycle info and charting help.

Hope this helps some.

Gatsby-
WOW you have done your research!! Thanks for the help. There is so much info out there and a lot of the Internet isn't always the most accurate source.
Again, I appreciate your help!

And here is an example of the very inaccurate side of the Internet.
I was doing a google search and found this on a website: "After you finish a cycle of clomiphene, your hypothalamus (the part of your brain that regulates basic functions such as temperature) releases luteinizing hormone (LH), which tells your ovaries to release your mature egg or eggs into your fallopian tubes."

Now wait, did it say that the hypothalamus releases LH?! While it probably doesn't matter to some women (I mean as long as it is released and you ovulate) but it is the anterior pituitary that releases LH. I promptly stopped reading and hit the back button on my browser. I couldn't have possibly believed their other stats if that little fact was so off...

hey guys i found this on fertilityfriend.com;
What are the best days to get pregnant? How often should I have intercourse when I am trying to get pregnant?


There are many factors which affect your probability of pregnancy. Your age, medical conditions, health, lifestyle and other factors all affect your likelihood of conceiving each cycle. You have varying degrees of control over many of these factors. The number one most important factor affecting your chances of conceiving, however, is something that you and your partner can control: the timing and frequency of intercourse in your fertile window.

What is the fertile window?

Your fertile window is made up of the days in your menstrual cycle when pregnancy is possible. The length of this fertile phase is determined by the maximum life span of your partner's sperm and your egg. Sperm can survive a maximum of five days in fertile cervical fluid and your ovum can survive for up to one day. Your theoretical fertile window is thus six days long, comprised of the five days before ovulation and the day of ovulation. You only have a chance to conceive when you have intercourse on these days. This means that pregnancy is technically possible from intercourse on any of these six days. The likelihood of actually becoming pregnant, however, is dramatically increased when you have intercourse in the three days immediately leading up to and including ovulation. This makes a practical fertile window of just three days.

In a recent analysis of 119,398 charts from women charting with Fertility Friend, we found that 94% of women who became pregnant had intercourse on at least one of these three days. For conception purposes, it is thus ideal to have intercourse during a three day fertile window which includes your ovulation day and the two previous days.


Intercourse Frequency

There has been some speculation that couples who are trying to conceive should reduce the frequency of sexual intercourse during the fertile window to increase sperm supply. This is not true for most couples. While couples with known male factor issues should consult their doctor for the best intercourse strategy, couples with normal fertility and no known sperm issues should not reduce the frequency of intercourse in the fertile window. Your probability of conception is increased when you have intercourse multiple times in your fertile window. While it is true that sperm concentrations decrease slightly with increasing intercourse frequency, frequent intercourse is still more likely to result in conception than infrequent intercourse for couples with no male factor fertility issues. Each additional act of intercourse within your fertile window increases your probability of conception for that cycle.

I am taking Clomid. When can I expect ovulation and how will it affect my chart?


In most cases, you can expect ovulation within 5-9 days of your last dose of Clomid, but the doctor who prescribed the medication for you should be able to give you a good indication of when to expect ovulation based on your own situation. He or she can also help you plan when to have intercourse based on when you are expecting ovulation.

You may notice that your temperatures are higher on the days you take the pills, but they should level out enough for ovulation to be detected on your chart when it occurs. Some women also notice that cervical fluid is not as abundant when taking Clomid.


Also, i am trying to find it but i beileve from my obgyn rotation that with regular ovulation there is a 20% chance of a woman getting pregnant every cycle.

I found this on emedicine;
Clomiphene citrate (Clomid, Serophene)

CC is a nonsteroidal estrogen capable of interacting with estrogen receptor–binding proteins in a manner similar to estrogen but in a more prolonged way (Clark, 1974; Clark 1981). Therefore, CC behaves similar to an antiestrogen.

CC has been in clinical use since the early 1960s. Its mechanism of action is still not well understood, but it competes for the estrogen receptor at the hypothalamus, pituitary, and ovarian levels. Because of the action at the estrogen-receptor level within the hypothalamus, CC alleviates the negative feedback effect exerted by endogenous estrogens (Tobias, 1981; Adashi, 1984; Kokia, 1990). As a result, CC normalizes the GnRH release; therefore, the secretion of FSH and LH is capable of normalized follicular recruitment, selection, and development to reestablish the normal process of ovulation (Tobias, 1981; Miyake, 1983).

The standard dose of CC is 50 mg PO qd for 5 days, starting on the fifth menstrual cycle day or after progestin-induced bleeding. As an antiestrogen, CC requires that the patient have some circulating estrogen levels; otherwise, the patient will not respond to the treatment. The CC response is monitored using pelvic ultrasound starting on the 12th menstrual cycle day. The follicle should develop to a diameter of 23-24 mm before a spontaneous LH surge occurs.

BBT can be used to observe the thermogenic shift (temperature rises 0.5°F above the basal level) induced by the early secretion of progesterone. The only disadvantage with BBT is that in many instances, the shift does not occur in a clear way, and the patient misses the time of ovulation. While BBT is an inexpensive way to monitor ovulation, it is often impractical.

Urinary monitoring of the LH surge (eg, with an LH Predictor Kit) can be a substitute for BBT. The patient should start monitoring the urinary LH secretion daily starting on the 12th menstrual cycle day. Ovulation usually occurs within the 32-40 hours after the indicative color change. Serum LH determination is more precise, especially when performed in combination with pelvic ultrasound. A postovulatory ultrasound should be performed during the first CC cycle to exclude the presence of LUF syndrome.

Because of the antiestrogenic effect, CC may desiccate the cervical mucus, creating an iatrogenic cervical factor that can be responsible for the lack of pregnancy in a patient who has otherwise ovulated (Shirai, 1972). Therefore, a PCT must be performed during the first CC cycle and every time the doses of CC are increased. Other adverse effects associated with CC are hot flashes, scotomas, dryness of the vagina, headache, and ovarian hyperstimulation, which, although rare, has been reported in patients who are sensitive to CC (Southam, 1962; Scommegna, 1969). Whether the use of CC increases the risk of ovarian cancer is unknown, although 2 articles illustrate a potential risk (Rossing, 1994). Other authorities disagree with this assumption.

The principal indications for CC use are in patients with oligomenorrhea, especially PCOD, and for patients with slight menstrual irregularities. CC is indicated in the treatment of patients with LPD due to small-size follicle development (van Hall, 1969; Garcia, 1977). Its use has been extended to ART.

The use of CC is contraindicated in cases of ovarian cyst, pregnancy, and liver disease. Its use is controversial in patients with a history of breast cancer.

I am so appreciative to everyone who posted a reply and shared her knowledge.
I read something about a woman who took prednisone with Clomid and it was the only way that it worked for her. Has anyone heard of this or can anyone tell me why this would be?

Yes, It works. Generic Clomid is an ovulatory stimulant used to treat female infertility. It can cause some side effects such as breast tenderness, blurred vision, headache, nausea and stomach upset. I got an info at internationaldrugmart.com; Some women get treatment that stimulates ovulation by producing more hormones and activate ovaries to release one or more eggs, use this Generic Clomid.