Traditional Clomiphene Citrate Administration vs. Stair-step Approach

The traditional administration of clomiphene citrate for ovulation induction involves taking clomiphene citrate for 5 days. If ovulation does not occur within 14 days, a progestin pill (such as Provera) is prescribed for 10 days to induce a period (which normally occurs within 1 week of stopping the pill). Then a higher dose of clomiphene citrate will be prescribed.

The stair-step administration of clomiphene citrate for ovulation induction also involves taking clomiphene citrate for 5 days. In contrast, if ovulation does not occur within 7-9 days, a progestin pill (such as Provera) would NOT be taken to induce a period. The dose of clomiphene will then be increased. Therefore, this would do away with the 10 days of taking the progestin pill, and also do away with waiting for a period (usually 3 to 7 days) for a total of up to a 20 day difference between clomiphene citrate dosing cycles.

Inclusion criteria

• Ovulatory dysfunction as evidenced by mid-luteal progesterone less then 3ng/dL, non-biphasic basal body temperature charting, or menstrual history of cycles > 35 days.
• Female patients 18 to 45 years old
• Six months or greater of unprotected intercourse without pregnancy.
• Normal TSH and prolactin serum levels
• Semen analysis of male partner with > 15 million motile sperm on semen analysis.

• NOTE: Must be willing to travel to the Oklahoma City area for treatment.

Exclusion criteria

• Failure to spontaneously menstruate or to menstruate following progestin administration
• Allergy or intolerance to the side effects of clomiphene citrate, hCG (human chorionic gonadotropins), or medroxyprogesterone acetate (Provera).
• Known anatomical defect affecting the uterine cavity including submucosal fibroids or endometrial polyps.
• Know tubal hydrosalpinx or risk factors for tubal obstruction
• Known liver dysfunction
• Known or suspected androgen secreting tumor, cushings disease, or adrenal hyperplasia (congenital or adult onset)
• Ovarian cyst > 20mm or endometrial lining >6 mm on trans-vaginal baseline ultrasound.
• Stage III or IV endometriosis
• Decreased ovarian reserve as evidenced by antral follicle count less than 6 by Transvaginal ultrasound or a cycle-day-3 serum FSH of > 10 uIU/ml.
• Positive HIV in either the female patient or her partner.