For example, Clomid treatment with a gynecologist often looks different from treatment by a fertility specialist. Sometimes Clomid is combined with IUI (intrauterine insemination) treatment. More frequently, it is prescribed to be timed with intercourse at home. This day-by-day guide to treatment will give you a general idea of what your cycle may look like when you take Clomid. As always, follow your healthcare provider’s instructions, and do not be shy about asking questions before, during, or after treatment. Write this date down. You will need to take Clomid on particular days of your cycle. You may also need to have certain tests done on specific days. If you only have spotting, call your healthcare provider’s office. You might never get a full flow. They can review your bloodwork to see where in your cycle you are. If you have irregular periods or you do not get a period, your healthcare provider can perform a “random start.” They will check your bloodwork to see whether you are baseline for Clomid start or not. If you have irregular periods, they also might prescribe the medication Provera (medroxyprogesterone), a form of progesterone. When you take this medication, it will induce a period. Your healthcare provider might want you to take a beta hCG pregnancy test (via blood work) to ensure you’re not pregnant. Your healthcare provider is looking for cysts on the ovaries, not to be confused with the tiny cysts one might see with polycystic ovaries. In this case, they are looking for a larger cyst. Usually, the ultrasound doesn’t find anything. If everything looks good, your cycle can go on as planned. If the ultrasound shows that you have a cyst, your healthcare provider will likely cancel this cycle. You may need to wait until next month to try again. If they do find a cyst, do not worry. These cysts are rarely harmful and will usually disappear on their own. The main downside is you will have to wait another month to start treatment. As always, ask your healthcare provider if you are concerned. Your healthcare provider may tell you to take the Clomid pills on one of the following sequences:

On cycle days 3, 4, 5, 6, and 7On cycle days 5, 6, 7, 8, and 9

Some providers will have you start treatment on cycle day 2 or cycle day 4, though this is less common. There doesn’t seem to be a difference in pregnancy success between beginning Clomid on day 3 or day 5. Different practitioners prefer to use different protocols. In some cases, your healthcare provider may ask you to change the start day on your next cycle, to see if it will make a difference for you. Ideally, take the Clomid at the same time every day. Some say that taking the pill before bed can help you sleep through some of the side effects. Others do better if they take the pill in the morning. If you have another Clomid cycle, you can try taking it at a different time of day. But don’t change the time of day once you start the cycle unless you speak to your healthcare provider first. In short, the hormone FSH (follicle-stimulating hormone) signals the ovaries to grow and mature eggs (encased in follicles of fluid) to be released via ovulation. As the follicles on the ovaries grow, they release estrogen. The increase in estrogen signals the brain to slow down the production of FSH. This, in turn, slows down the stimulation of the ovaries. Clomid works by tricking the brain into thinking your estrogen levels are unusually low. It does this by blocking estrogen from binding to its receptor. So, although estrogen is circulating in your bloodstream, the receptors are unable to detect it. Thinking there are no growing follicles because estrogen appears to be low, your body responds by releasing more gonadotropin-releasing hormone (GnRH). GnRH then signals your pituitary gland to produce more FSH and LH (luteinizing hormone). The higher levels of FSH stimulate the ovaries, and the higher levels of LH eventually trigger ovulation. Even though you take Clomid for only 5 days, the chain reaction that starts with your first pill continues throughout the month. This is one reason why you may continue to experience some side effects days after you take your last dose.

To keep an eye on how many follicles grow, so they can cancel the cycle if more than one or two appear To time a trigger shot or an IUI (intrauterine insemination)

Monitoring the cycle usually starts a few days after your last Clomid pill is taken and may involve ultrasounds and bloodwork every few days until you ovulate. The ultrasound technician will measure the growing follicles, and your healthcare provider will decide based on their growth when to time a trigger shot (if you’re having one), an IUI, or intercourse for the cycle. If two follicles develop to a mature size, your provider may or may not advise you to skip the cycle. Two large follicles raise your odds for conceiving twins, but it is not guaranteed. Tell your healthcare provider if it is important to you to avoid conceiving twins, so they can better advise you on what to do. If three or more follicles mature, your healthcare provider will likely cancel the cycle, meaning you will be asked not to have sex (to avoid conceiving). And if an IUI or trigger shot was planned, neither will be given to avoid a higher multiple pregnancy, which carries serious risks to you and your future babies. If your cycle is canceled, as tempting as it may be to ignore your provider and have sex anyway, you should take your provider’s warnings seriously. It may be a good sign that your body reacts to Clomid so sensitively. Hopefully, next time your healthcare provider can adjust your treatment so as not to stimulate as many eggs. It is better to wait until next time than end up with a high-risk pregnancy. You may have heard of hCG (the pregnancy hormone) when reading about pregnancy tests. In the body, hCG acts a lot like LH, which is the hormone that peaks just before ovulation and signals the follicles to rupture and release an egg. The trigger shot is usually given 7 to 9 days after your last Clomid pill, but it may be given later than this if ultrasound monitoring finds that your eggs need more time to mature before getting kicked out of their cozy follicle beds. Ovulation can, however, occur even later than 10 days after your last Clomid pill, so it is something to keep in mind. If you were given a trigger shot, then ovulation will occur 24 to 36 hours after the injection. Unless your healthcare provider tells you otherwise, you should begin having sex every other day or every day, starting 3 days after you take your last Clomid pill. You should continue having sex until you have confirmed that ovulation occurred. You may get confirmation from a body basal temperature (BBT) chart or a progesterone blood test (given on day 21 of the cycle). If you are doing an IUI cycle, your healthcare provider will tell you when to come in for the IUI based on your ultrasounds and the timing of your trigger shot. In most cases, you can also have sex on your fertile days at home in addition to your IUI. Progesterone is a hormone that rises after ovulation, and testing for it can confirm whether or not Clomid triggered ovulation. Another reason for testing progesterone levels is to ensure levels are not too low. If they are, your healthcare provider may order a progesterone vaginal suppository as a supplement. During the two-week wait, you may experience mild symptoms of ovarian hyperstimulation syndrome (OHSS). The most common symptom of OHSS is bloating. A severe case is rare when taking Clomid, but it can occur. Be sure to contact your healthcare provider if your symptoms are severe or if you are concerned. It is also possible they will simply ask you to take an at-home pregnancy test sometime between days 28 and 35 of your cycle and instruct you to call if you get a positive result. If the test is positive, congratulations! Your healthcare provider will likely monitor the pregnancy for a few weeks to be sure everything is going smoothly, and to check if you have conceived twins (or more). If you are feeling more nervous than excited, be reassured that it is normal. Pregnancy after infertility is not always easy, especially emotionally. Having an unsuccessful cycle can be upsetting, and it is common to feel defeated and lose some hope. Remember that you can try again and that sometimes treatment needs adjustments before you reach success. How your healthcare provider addresses a failed Clomid cycle will depend on your situation. Every case will be different, but here are some possibilities of how it might be addressed.

No Changes

Another cycle of Clomid at the same dose you just used may be used. Just because the cycle didn’t lead to pregnancy doesn’t necessarily mean anything about your treatment should be adjusted right away. You just might need another try or two. Remember that even people with good fertility rarely conceive the first cycle they try. The same could be said about Clomid or any fertility treatment.

Higher Dose

If you didn’t ovulate, another cycle of Clomid at a higher dose may be the next step. The first cycle of Clomid is typically started at 50 milligrams, but many people won’t ovulate at that dosage. If this happens to you, the dosage may be increased. Your healthcare provider will probably keep trying higher dosage levels up until a certain point, after which other treatments might be considered. People who don’t ovulate on Clomid are sometimes called Clomid resistant. There are a variety of options if this happens to you, including switching to the drug letrozole or taking Clomid along with metformin.

New Treatment Options

If three to six cycles of Clomid don’t lead to pregnancy, new treatment options may be considered. Six cycles of Clomid is considered to be the top limit, though some healthcare providers suggest moving on if pregnancy doesn’t occur by the third treatment cycle.