Ovulation Induction Using Clomiphene and FSH (Clomid and Follistim): Patient instructions

1. Call with the onset of your menses: (the most important step). If the first full day of flow is on a weekend or holiday it is not necessary to call the office until the next business day. You may be asked to come to the office before beginning the medication, for a blood test and or an ultrasound. We will instruct you appropriately during this initial telephone call.
2. Start Clomiphene: your dose will be decided prior to starting the cycle and the medications ordered in advance. You will be instructed when to begin taking the drug (usually cycle day three). The medication is given for five days. We recommend that you take the medication at bedtime to minimize side effects.
3. Come to the office after finishing Clomiphene: we will confirm the dates with you. You’ll have a blood test and an ultrasound on that day to assess the effect of Clomiphene on your ovaries.
4. Start FSH Injections: The injections are administered daily. The clinician will determine the dose and duration of the daily injections. You will receive specific instruction on the proper injection technique. You will be asked to return for another monitoring visit generally 2–3 days after you begin the injections. YOU DO NOT NEED TO USE AN OVULATION KIT.
5. Second monitoring visit: during your first monitoring visit we will indicate to you when to expect the color change on your predictor kit. We will also instruct you when to come into the office if the color change does not occur. The monitoring visits again consist of blood tests and an ultrasound and will determine how close you are to ovulation. In some cases a third monitoring visit may be required. This is more likely in the first cycle when the individual pattern of response to it not yet known.
6. Ovulation: When using this drug combination it is necessary to trigger the ovulation using hCG. The dose and timing of the hCG injection will be determined based on your response to therapy. We can then direct you to have intercourse or come in for intrauterine insemination at the optimal time.
7. Intrauterine insemination (IUI): in many cases insemination is recommended. We generally perform two sessions of intrauterine insemination each cycle on consecutive days. The inseminations will be timed to your ovulation. See the intrauterine insemination instruction sheet.
8. Luteal phase supplements: during the two weeks. Starting at the ovulation you will receive hormone supplements to support a pregnancy that may have begun. You will be counseled individually about your specific hormone protocol at the time of ovulation or insemination.