When should Clomid (clomiphene citrate) be started in a menstrual cycle for treating anovulation-related infertility?

When to Start Clomid for Anovulation-Related Infertility

Clomid (clomiphene citrate) should be started on or about the 5th day of the menstrual cycle when treating anovulation-related infertility. 1

Timing Protocol for Clomid Administration

For Women with Regular Menstrual Cycles:

• Start Clomid on cycle day 5 (where day 1 is the first day of menstrual bleeding)
• Continue for 5 consecutive days (days 5-9 of the cycle)
• Initial recommended dose: 50 mg daily (1 tablet)

For Women with Irregular/Absent Cycles:

• If no recent uterine bleeding: Clomid can be started at any time after pregnancy has been excluded
• If using progestin-induced withdrawal bleeding: Start Clomid on day 5 of the induced bleeding
• Same 5-day regimen applies

Dosage Considerations

• Begin with 50 mg daily for 5 days
• If ovulation does not occur after the first course, increase to 100 mg daily for 5 days in the next cycle
• Do not exceed 100 mg/day or extend treatment beyond 5 days per cycle
• Wait at least 30 days between treatment courses
• Maximum recommended treatment: 6 total cycles (including 3 ovulatory cycles) 1

Monitoring and Timing of Intercourse

• Ovulation typically occurs 5-10 days after completing the Clomid course
• Time intercourse to coincide with expected ovulation
• Consider using basal body temperature charts or other ovulation prediction methods
• Ultrasound monitoring is recommended to:
  • Track follicular development
  • Minimize risk of multiple pregnancy
  • Adjust dosing for subsequent cycles 2

Important Considerations and Precautions

Pre-Treatment Assessment

• Confirm anovulation as the cause of infertility
• Exclude pregnancy before starting each treatment cycle
• Verify absence of ovarian cysts (except in PCOS patients)
• Ensure normal liver function
• Confirm adequate endogenous estrogen levels 1

Contraindications

• Pregnancy
• Abnormal vaginal bleeding (without proper evaluation)
• Ovarian cysts (except in PCOS)
• Liver disease
• History of visual disorders 3

Potential Adverse Effects

• Multiple pregnancy (5-8%)
• Ovarian hyperstimulation syndrome
• Visual disturbances
• Hot flashes
• Abdominal discomfort 2

Special Populations

Overweight/Obese Patients

• Higher BMI is associated with decreased response to Clomid
• Weight reduction should be an important part of therapy before or during treatment 2, 4

PCOS Patients

• Particularly responsive to Clomid therapy
• May require lower doses due to potential sensitivity to pituitary gonadotropin 1
• Consider insulin-sensitizing agents (e.g., metformin) as adjunctive therapy in insulin-resistant PCOS patients 3

When to Consider Alternative Treatments

• After failure to ovulate following three treatment courses
• After six ovulatory cycles without pregnancy
• When other fertility factors are present
• In women with clomiphene resistance

Remember that proper timing of Clomid administration is crucial for successful ovulation induction. Starting on day 5 of the menstrual cycle allows for optimal follicular development and subsequent ovulation in most women with anovulatory infertility.