Clomiphene Citrate  (Clomid)

This drug is most often used to stimulate ovulation in women who have infrequent or absent ovulation; it is also used as an empiric treatment for unexplained infertility.  The standard dose is 50 mg per day for five consecutive days.  Ovulation rates, pregnancy rates, and pregnancy outcomes are similar regardless of whether treatment begins on cycle day 2,3, 4, or 5.  Typically we start this medication on day 5 of your cycle (with day 1 being the first day of your period). 

Clomiphene works by causing the pituitary gland to secrete more FSH (a hormone), which sends a signal to the ovaries to develop follicles (eggs).  To find out whether your body is ovulating on a specific dose of clomiphene, a blood test checking your progesterone is usually performed on day 21-23 of your cycle.  If ovulation does not occur on 50 mg, the dose may be increased by 50 mg increments until ovulation occurs. 

Clomiphene will induce ovulation in about 80% of women.  About 40-45% of couples receiving clomiphene will become pregnant within six cycles.  Women who are overweight may have better success if weight is lost. 

Side effects are relatively common, but mild.  Hot flashes occur in about 10% of women; mood swings, breast tenderness, and nausea may occur.  Severe headaches or visual problems are uncommon and virtually always reversible. 

Women who conceive with clomiphene have approximately a 10% chance of having twins.  Triplet and higher order pregnancies are rare, <1%.  There is no increased risk of miscarriage in pregnancies conceived with clomiphene.  Ovarian cysts may occur as a result of the stimulation of the ovaries. 

Quick take:

1) Day 1 is the first day of your period.

2) Clomid starts day 5, and is taken daily for 5 days.

3) Blood test for progesterone on day 21-23.