What is the recommended dose of Clomid (clomiphene citrate) for inducing ovulation?

Recommended Dose of Clomid for Ovulation Induction

The recommended initial dose of Clomid (clomiphene citrate) for ovulation induction is 50 mg daily for 5 days, starting on day 5 of the menstrual cycle, with dose increases to 100 mg daily for 5 days if ovulation does not occur after the first course. 1

Dosing Protocol

Initial Treatment

• Start with 50 mg daily (1 tablet) for 5 days
• Begin treatment on or about day 5 of the menstrual cycle if spontaneous or progestin-induced bleeding has occurred
• If no recent uterine bleeding, treatment can be started at any time

Follow-up Treatment

• If ovulation occurs with the 50 mg dose, maintain this dosage for subsequent cycles
• If ovulation does not occur after the first course, increase to 100 mg daily (two 50 mg tablets as a single dose) for 5 days
• Second course can be started as early as 30 days after the previous one (after excluding pregnancy)
• Do not exceed 100 mg/day or extend treatment beyond 5 days per cycle

Treatment Duration Limitations

• If ovulation does not occur after three courses of therapy, discontinue clomiphene citrate and reevaluate the patient
• If three ovulatory responses occur without pregnancy, further treatment is not recommended
• Long-term cyclic therapy should not exceed approximately six cycles 1, 2

Special Considerations

Patient Selection

• Lower doses are particularly recommended for patients with suspected sensitivity to pituitary gonadotropins, such as those with polycystic ovary syndrome (PCOS) 1
• Women with functional hypothalamic amenorrhea (FHA) should achieve a BMI ≥18.5 kg/m² before ovulation induction 3

Monitoring

• Monitor at least the first cycle with ultrasonography to assess follicular development and minimize risk of multiple pregnancy 4
• Ovulation typically occurs 5-10 days after completing a course of clomiphene citrate 1
• Appropriate tests to determine ovulation may be useful during this time

Efficacy and Response

• The majority of patients who will respond to clomiphene will do so after the first course of therapy 1
• Approximately 70% of treated patients will ovulate with doses up to 200 mg/day 5
• Cumulative conception rates approach normal population rates by treatment cycle 12 2

Potential Adverse Effects

• Multiple pregnancies (increased risk with multiple follicular development)
• Ovarian hyperstimulation syndrome
• Effects on cervical mucus and endometrial function may impair fertility in some women 5

Special Situations

Clomiphene Resistance

• For clomiphene-resistant patients, consider factors such as obesity, hyperandrogenemia, and insulin resistance 4
• Alternative approaches for clomiphene-resistant patients include gonadotropin therapy or laparoscopic ovarian drilling 4

Low-Dose Protocol

• In highly sensitive patients who develop functional ovarian cysts at standard doses, doses as low as 12.5 mg daily for 5 days have been effective 6
• Using 50 mg doses may minimize side effects while maintaining similar efficacy to higher doses 5

Important Caution

Do not increase the dosage or duration of therapy beyond 100 mg/day for 5 days, as this does not improve outcomes and may increase risks 1.