Clomid = Clomiphene Citrate; Tamoxifen = Nolvadex

There are 3 reasons for a woman to use this fertility treatment:

• To induce ovulation in a woman who doesn’t routinely ovulate on her own.
• To enhance fertility in a woman who is having trouble conceiving despite regularly ovulating on her own.
• To help time ovulation with sperm insemination therapy when indicated.

The effectiveness of this therapy depends on many factors, such as the age of the woman, the condition of her fallopian tubes, and the quantity of her partner’s sperm. In general, the average pregnancy rate is 10 – 20% per try. Not all women will ovulate with this treatment and not all those that ovulate will conceive. Usually 3 cycles constitutes a sufficient try with this therapy, but in some situations we will allow up to 6 cycles.

Side effects can occur with this medicine up to 10% of the time. They are usually mild and never life-threatening. The most common side effect is hot flashes which can last up to 10 days. Moodiness, nausea, headaches, and breast tenderness can also occur. Abdominal bloating/discomfort is often experienced as the ovaries grow. If you develop visual blurring or spots/flashes before your eyes, call us as you may need to discontinue the therapy in that case.

The incidence of twins (7%) from the use of Oral Ovulation Medication is greater than in the general pregnant population (2%). The chance for triplets or beyond is EXTREMELY rare.

The use of Clomid or Tamoxifen for more than 11 cycles in a woman’s lifetime is generally discouraged because such prolonged exposure has been linked in one study to a higher risk of borderline ovarian tumors in future years.

Directions for Clomid/Tamoxifen Use:

•  Our office will tell you what dose of Clomid or Tamoxifen to take. Take the dose every day for 5 straight days. If your dose is more than one pill per day, take them together at the same time each day. Begin the pills on the 3rd day of your cycle (though if you have missed that “start day,” you can begin them as late as day 5 of the cycle but you must inform our office of this). We count the first day of full flow (not just spotting) as “day one.”
• Call our office early in your cycle to set up an ultrasound in our office to visualize the ovarian follicle(s) on day 12 or 13 of your cycle. The ultrasound allows us to confirm that an egg-containing follicle has matured to full size and we can determine which ovary will release the egg and how many eggs might be released. Sometimes a second ultrasound visit is needed a few days later if the follicle is not yet full size.
•  On rare occasions your doctor may advise you to prepare for a “post-coital test” at the time of the ultrasound. Your preparation for this test means you have sexual relations between 2-12 hours prior to your appointment. Sometimes this is useful to determine if an intrauterine insemination should be pursued.
• If you are planning an insemination, you will need to trigger the release of the egg(s) with a shot of HCG medicine. The egg(s) release 36-40 hours after the injection. Depending on the size of your follicle, the shot may be given by our nurse at the time of your visit or, alternatively, you would be responsible for administering it at home (usually in the late evening). Inseminations are performed in the morning 24 to 36 hours after the shot. Your partner should plan to abstain from ejaculationfor at least 24 hours before collecting for the IUI specimen.
  Regardless of whether an insemination is planned, we recommend that you have sexual intercourse with your partner every 2-3 days beginning by cycle day 10.
• Approximately one week after ovulation, you will need to get a blood test drawn at one of our offices or at your local blood-drawing station (such as Quest or Labcorp) to check your progesterone level. This helps us assess the quality of your ovulation and determines if you need to change your dose of medicine in a future cycle.
• If you do not get a period by 16 days after your expected day of ovulation then you should call us to schedule a blood pregnancy test and progesterone level. You may, in addition, do a home pregnancy test for a rapid result.
• If you are not pregnant after 3 cycles we usually recommend that you make an appointment for another consultation in our office to discuss other treatment options available to you.