I am on my first Clomid cycle. My OB/GYN is not monitoring me. Should I change doctors? I am very concerned that I am not getting proper care. --Diane

Sorry, I can't tell you to change doctors. But while many doctors place women on clomiphene and wait to see what happens, I believe this is not the best approach. Following is information from my website on how I use clomiphene with my patients. This is just one of many acceptable methods for treating anovulation, but I believe it's the most effective and respects the fact that you likely want to be pregnant yesterday.

When menstrual flow begins, before day three, I would see you for a "clomiphene check." You'll need this check each month before I give you a new clomiphene prescription. The clomiphene check allows us to review your previous treatment cycle; a pelvic exam or ultrasound ensures that the clomiphene has not stimulated the development of an enlarged ovarian cyst. If your exam is normal and the clomiphene is working properly, you will get another prescription, to start on day three of your cycle. If either you or I think you might be pregnant, I do not give you clomiphene, as it may increase your risk of birth defects. IF YOU THINK YOU MAY BE PREGNANT, DO NOT TAKE CLOMIPHENE. CALL YOUR DOCTOR!

You take a single clomiphene 50mg tablet daily from the third through the seventh day. Two or three days later, I do a bloodtest to check the levels of the hormones LH and FSH. If the LH is three times the FSH level, then you most likely have severe polycystic ovarian disease and clomiphene is unlikely to work for you.

On cycle day 12 you begin daily urine testing to detect an LH surge, the signal that ovulation will occur within 24-36 hours. (Checking too early can produce a falsely positive indication of ovulation.) When the surge occurs, we do an ultrasound to confirm that you have developed a normal follicle and that the uterine lining is ready. If you do not have a surge by the 16-18th cycle day, we do an ultrasound to check for follicular development and measure the thickness of the uterine lining. If you have a follicle larger than 19mm and the endometrium greater than 7mm thick, I would give you an hCG injection to trigger the release of one or more eggs. If things are almost ready, you can continue checking your urine and get the hCG in 1-2 days. If follicular development is good but the uterine lining has not yet developed, we'll check your estrogen level. If follicular development is poor, the cycle will be canceled and next month you'll get a larger dose.

More than half of clomiphene pregnancies occur during the first three cycles, and more than three-fourths occur at the 50mg dose. Rarely will pregnancy occur when more than 100mg/day (two tablets) are necessary. If you have not conceived after three cycles, intrauterine insemination may improve your chances of conceiving.