In women that menstruate regularly on their own, clomiphene may be used to help the ovaries to produce more than one mature egg. This is sometimes referred to as "superovulation." The process is as follows:
On Day 3 of the menstrual period, a course of clomiphene is begun. Starting clomiphene early in the cycle helps with the recruitment of more than one mature egg.
Typically, two clomiphene citrate 50-mg tablets are taken orally for 5 days, from cycle day 3 to cycle day 7.
On day 11 or 12 of the menstrual cycle, ultrasound monitoring is conducted to determine if an ovarian follicle or follicles have developed. The ultrasound helps to determine how many mature eggs are forming within their follicles. In order for ovulation induction to be successful, 2-3 follicles should be visible at this point (with just one follicle, we would not be significantly enhancing a woman's chances to become pregnant). When an ovarian follicle matures, it produces the hormone estrogen, which causes the lining to thicken in preparation for an implanting embryo. Ultrasound monitoring at this stage also serves to measure the endometrial (uterine) lining and to make sure the clomiphene itself is not having any adverse effects on the endometrium (see Clomiphene side effects, below),
At this stage, patients are also asked to use an ovulation predictor kit to test for a surge in LH hormone, indicating imminent ovulation. In most cases, patients are given an injection of hCG (human chorionic gonadotropin) also known as Ovidrel. This hormone initiates the release of the egg (ovulation) and the development of the corpus luteum, which will help the body to produce progesterone. Ovulation usually occurs approximately 38-44 hours after the hCG injection.
After ovulation, a form of the hormone progesterone is given via vaginal tablets or gel in order to support the endometrial (uterine) lining and prepare it for the fertilized egg.
Patients are asked to take a home pregnancy test (urine test) two weeks after ovulation. If the home test is positive, a blood test will be performed to confirm the results.
If the clomiphene cycle did not produce sufficient egg follicles, it may be possible to begin another cycle immediately; or, if residual cysts are present on the ovarian follicles, a rest cycle may be advised before resuming treatment.