CLOMIPHENE / LETROZOLE PROTOCOL
Ovulatory Stimulation With Clomid/Letrozole and IUI
If either you or your physician suspect you might be pregnant, do not take clomiphene/letrozole as there may be a possibility of increased risk of congenital defects. IF YOU THINK YOU MAY BE PREGNANT, DO NOT TAKE CLOMIPHENE/LETROZOLE. NOTIFY YOUR PHYSICIAN!
- Before starting a clomiphene (or letrozole) cycle preparing for IUI (intrauterine insemination), a baseline ultrasound on or before cycle day 3 would be scheduled.
- Beginning on cycle day 3, start taking clomiphene citrate 50 mg (or letrozole 2.5 mg) by mouth each day through cycle day 7. Medication should be taken as close to the same time every day as possible.
- For those patients where a combined clomiphene (or letrozole)/FSH or HMG/intrauterine insemination protocol has been advised, an injection of 150 units of FSH or HMG (Bravelle/Gonal-F or Repronex) will be administered on day 8 or 9. (You and your physician would have discussed this prior to starting your cycle.)
- On cycle 9 or 10, schedule appointment for lab work (LH and FSH), unless advised differently by your physician. (These labs are done with the first cycle only.) If the LH level is two to three times higher than the FSH level, clomiphene/letrozole is less likely to work for you. An ultrasound may be considered on cycle day 10 or 11. This will be determined by your physician. The ultrasound is done to confirm that you have developed a normal follicle and that the uterine lining is ready.
- On cycle 12, you will begin daily testing of urine to detect an LH surge, the signal that ovulation will occur in 24-36 hours. Ovulation predictor kits (LH predictor) may be purchased here at GRS or at most any pharmacy. The LH urine test is best performed with the second urination of the day (usually between 7 a.m. and 10 a.m.)
- When the surge occurs, call the office to schedule a time for your IUI for the following day. Please call no later than 11 a.m. (Note: surge is any color change that is close to the "control". May be lighter with clomid.)
If a surge occurs on the weekend, please call the physician on call for instructions.
Frequently the male partner will choose to abstain from intercourse or ejaculation in order to "save things up" for the big day. We advise against this strategy. Semen specimens are optimized by maintaining regular sexual activity every two or three days throughout the cycle prior to ovulation. We ask that you abstain from intercourse / ejaculation 2-3 days prior to IUI.
- If you do not have a surge by the 16th cycle day, call office to schedule an ultrasound. This is done to check for follicular development and measure the thickness of the uterine lining. If things are ready (follicle >19 mm and endometrium >7 mm) an hCG injection is given to trigger release of egg (s).
- If things are almost ready, you can continue checking your urine and hCG (a medication given by injection to stimulate ovulation (egg maturity) may be given 1-2 days later.
- If follicular development is good but the uterine lining has not yet developed, an estrogen level may be checked.
- If follicular development is poor, the cycle will be canceled and next month a larger dose of clomiphene citrate or letrozole may be administered.
- If the cycle is cancelled, and another cycle is to be started, the protocol is followed again from step 1 above.