Clomid and Conception: Timing & What to Do When Cycles Are Irregular

Question
i am 27 and me and my partner have been trying to conceive for over a year now. my periods are sometimes month to month then some i skip a month. i am wanting to start clomid but i am unsure on when to start it if i haven't started a cycle. i had one aug 27, Sept 29, today is Nov 4th and i have no signs of it coming and my preg. test is neg. please let me know what i should do.

Answer
Hello Liz,

First of all, find a new doctor that knows what they are doing.  I cannot emphasize that enough.  It doesn't sound like your doctor is treating you appropriately.

Because of your irregular cycles, everything should be programmed.  1.  Your doctor should be checking a pregnancy test first, just in case.  
2.  If that is negative, then he/she should give you a medication called Provera or Prometrium for 5 days to start your period.  
3.  Once your period starts, an ultrasound needs to be done to make sure you don't have an ovarian cyst (which can prevent menses and ovulation), which is a contra-indication for taking Clomid.
4.  If no cyst is present, your doctor should give you the Clomid for this cycle, not more than one cycle.  You will take the medication on cycle day # 3-7 or #5-9.
5.  You should stop intercourse from cycle day # 10.
6.  You should return on or about cycle day # 10 to begin ultrasounds to see (1) if you are responding to that dose of Clomid, (2) how many follicles are growing (the cycle is cancelled if there are more than three), and (3) to time when to given HCG and induce ovulation.
7.  Once HCG is given, you begin intercourse the next day and daily, once per day for four consecutive days.

This is how a Clomid cycle should be done.  If you doctor does it differently, or just gives the medication and tells you to try for several months, he/she does not know what he/she is doing and you should seek out a real fertility specialist.

I hope this helps.

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.