INDICATION:

Clomiphene (Serophene, Clomid) is a medication that is given orally (by mouth) for 5 days out of each menstrual cycle. It is usually taken on menstrual days 3-7 or 5-9 as determined by your physician. This medication stimulates the pituitary gland to signal the ovary to produce an egg. Some indications for the use of clomiphene include the treatment of patients with prolonged cycles, irregular menses, and polycystic ovaries to induce ovulation. Follicular monitoring with clomiphene, hCG, and insemination is utilized for unexplained infertility timing donor inseminations, and timing cycles that are difficult to monitor by LH kit or temperature charts.

MONITORING OF CLOMIPHENE CYCLE:

Different women respond to clomiphene at different rates. The treatment plan starts with clomiphene 50 mg (1 tablet) daily for 5 days. If there is no evidence of ovulation, the dose of medication increases by 50 mg daily each cycle until ovulation occurs. If adequate ovulation has occurred, you will probably continue that dosage for 4 cycles prior to further evaluation.

Some women will time their cycles with temperature charts and a urine ovulation predictor kit while some women may require ultrasound monitoring of the follicles in the ovary. Ultrasound monitoring of follicular development using a vaginal probe ultrasound will usually start around day 10 of your menstrual cycle. (But this will be individualized by your physician when setting up your follicular monitoring plan. Please call 720-848-1690 to schedule an ultrasound appointment.) These ultrasounds will continue until the size of the follicle(s) indicate that the egg(s) are mature. At that point, an injection of hCG (human chorionic gonadotropin) will be given that evening around 10:00 pm to trigger ovulation. (A teaching class to learn how to give this injection is given in the office. Please call to schedule this in advance of beginning your monitored cycle if your physician states hCG and insemination is needed.) Ovulation usually occurs 36 hours after hCG administration. To increase the amount of sperm reaching the egg, an intrauterine insemination (IUI) MAY be scheduled for the approximate time of ovulation (24 to 39 hours after hCG injection).

IUI (INTRAUTERINE INSEMINATION):

Intrauterine insemination is a procedure that allows the practitioner to deposit sperm directly into the uterus via a small, flexible catheter. It requires that your partner bring in a semen sample at 8:00 am or produce the sample at the office at 8:00 am. The sample is then processed (it takes 1½ hours to process) and concentrated by our laboratory. Plan to return to the office between 9:30 and 11:00 am for the insemination. The insemination procedure usually takes a few minutes. During the procedure you may experience minimal cramping. Afterwards you can resume your normal activity.

POST-INSEMINATION INSTRUCTIONS:

1. If an endometrial biopsy is indicated for one of your cycles, a blood pregnancy test will be ordered for 9-12 days after your insemination. If this test is negative, the endometrial biopsy will be performed. Please be sure to get a lab slip for the pregnancy test and schedule your endometrial biopsy with the receptionist.
2. If you are late with your period (16 days after hCG), call to set up a blood pregnancy test.
3. When your menses begin, please call the office during regular business hours so that the plan for your next cycle can be discussed and reviewed with you.

RISKS:

Clomiphene is associated with a slightly increased risk (5-8%) of multiple pregnancy (more than one baby during pregnancy, i.e., twins, triplets, quadruplets, etc.). There is no evidence of an increased risk of birth defects or miscarriages in women taking clomiphene.

SIDE EFFECTS:

Side effects of clomiphene that may be encountered during the cycle are nausea, irritability, hot flashes, headache, breast tenderness, and mood swings. Occasionally a patient may experience ovarian cyst formation; these cysts will regress on their own. There may be mild midcycle abdominal pain at the time of ovulation--this is normal. Visual changes (i.e., light flashes) are rare (less than 1%) and are temporary, but you should notify us if they occur.

INDIVIDUAL PLAN:

1. _____ Clomiphene, hCG, IUI, USN monitoring
   _____ Clomiphene, hCG, intercourse
   _____ Clomiphene and insemination
   _____ Clomiphene and intercourse

2. _____ Arrange injection teaching class

3. Dose _____ tablets daily for 5 days

4. Start medication
   _____ cycle day 3
   _____ cycle day 5

5. With onset of menses
   _____ Schedule baseline ultrasound on or prior to CD 3. Call 720-848-1690 to arrange.
   _____ Start medication as ordered without baseline ultrasound.
   _____ Basal body temperature charts
   _____ Urine LH predictor Kit CD
   _____ Follicular monitoring starting CD 10 or 11

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