Can you start taking Clomid (clomiphene citrate) at any time?

When to Start Taking Clomid (Clomiphene Citrate)

Clomid (clomiphene citrate) should be started on or about the 5th day of the menstrual cycle if progestin-induced bleeding is planned or if spontaneous uterine bleeding occurs prior to therapy. 1

Timing of Clomid Administration

• For women with regular menstrual cycles, Clomid therapy should begin on approximately day 5 of the menstrual cycle (where day 1 is the first day of menstrual bleeding) 1
• For women with no recent uterine bleeding, Clomid can be started at any time, after pregnancy has been excluded 1
• The standard regimen is 50 mg daily for 5 days as the initial treatment course 1

Monitoring and Follow-Up

• Ovulation typically occurs 5-10 days after completing a course of Clomid 1
• Sexual intercourse should be timed to coincide with the expected time of ovulation 1
• Appropriate tests to determine ovulation may be useful during this time 1
• If ovulation does not occur after the first course, a second course of 100 mg daily for 5 days can be started as early as 30 days after the previous course, after excluding pregnancy 1

Important Considerations

• Before starting Clomid, a thorough diagnostic evaluation should be performed to identify any impediments to achieving pregnancy 1
• The therapeutic plan should be outlined in advance with the patient 1
• A low dosage is particularly recommended for patients with suspected sensitivity to pituitary gonadotropins, such as those with polycystic ovary syndrome, to reduce the risk of ovarian hyperstimulation syndrome 1
• Ultrasound monitoring during treatment is important to determine appropriate dosing for subsequent cycles and to minimize risks of hyperstimulation and multiple pregnancy 2

Duration of Treatment

• If ovulation occurs at the initial 50 mg dosage, there is no advantage to increasing the dose in subsequent cycles 1
• The majority of women who will respond to Clomid will do so after the first course of therapy 1
• If ovulation does not occur after three courses of therapy, further treatment with Clomid is not recommended, and the patient should be reevaluated 1
• If three ovulatory responses occur but pregnancy is not achieved, further treatment is not recommended 1
• Long-term cyclic therapy beyond a total of about six cycles is not recommended 1
• Some experts suggest that treatment could be extended to 12 cycles in responsive women before considering more complex methods of ovulation induction 2

Efficacy and Outcomes

• Clomid is the first-line treatment for normally estrogenized, anovulatory women 2
• The majority of women with "pure" anovulatory infertility respond to Clomid treatment 2
• Pregnancy and miscarriage rates with Clomid are close to those expected in a normal fertile population 2
• Increased body mass index is consistently associated with decreased response to Clomid, suggesting that weight reduction should be part of therapy in overweight anovulatory women 2

Potential Adverse Effects

• Multiple follicular development can occur, with risks of ovarian hyperstimulation and multiple pregnancy 2
• Mood changes and psychological adverse effects can occur during Clomid treatment 3
• Prolonged use of Clomid may be associated with an increased risk of ovarian tumors 2