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Doctor's responses 3-19-2010
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DUKE MEDICINE
Susannah D Copland, MD, MS posted:
Hello,

Several lines of discussions are interested in clomiphene. Here are some thoughts and responses to questions:

Clomiphene is structurally similar to estrogen. When taken early in a menstrual cycle, it tricks the the hypothalamus (a part of the brain that controls the menstrual cycle) into behaving as if estrogen were low. The hypothalamus pushes the pituitary gland to put out more follicle stimulating hormone, and the ovary gets a bigger push toward ovulation.

80% of women who do not ovulate will respond to clomiphene and ovulate.

If the ovary is responding, most will see a LH surge on ovulation predictor kit between 5 and 12 days after the last clomiphene pill.

Because the ovary can respond with more than one follicle/egg, clomiphene has an 8% risk of twins.

Because 3/4 of women who do not ovulate will be pregnant by 6-9 cycles of clomiphene, most doctors will start looking into different treatment options if a patient has completed 6 cycles without getting pregnant.

In women who do ovulate, clomiphene can be used to increase the number of eggs released. Many times intrauterine insemination is used to maximize pregnancy rates. Clomiphene has a lower success rate per cycle in women who are already ovulating. In women who do not ovulate, clomiphene has a 15-20% chance of pregnancy per cycle. In women who do ovulate, clomid with insemination has a 8-10% chance of pregnancy per cycle (2-3 x the pregnancy rate of women with infertility who do not use clomiphene with insemination).

Now to the specific posts:

Ovulating


ladyjane1025 Because clomiphene can cause your ovary to release more than one egg, you may perceive ovulation more. Pelvic discomfort is perceived is reported by some women using clomiphene. The smiley on your kit is a positive LH surge. The egg is released 24-48 hours later, so intercourse on the day of the surge and the day after will get sperm there before the egg is released.

Follicle growth

Anon_6592
If a woman is using hCG shots to trigger ovulation, we will usually give the shot when the follicle is 18-22 mm in diameter, however we see pregnancies with smaller and larger follicles too.

Have a great week!
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