How to Take Clomid for Infertility

A Day-by-Day Guide to Treatment

How do you take Clomid (clomiphene) for infertility? If your doctor has prescribed this popular fertility drug, you're probably curious about what to expect. Of course, treatment will vary from person to person, depending on some factors.

For example, Clomid treatment with a gynecologist often looks different from treatment by a fertility specialist. Sometimes Clomid is combined with IUI (intrauterine insemination) treatment. More frequently, it's prescribed to be timed with intercourse at home. This day-by-day guide to treatment will give you a general idea of what your cycle may look like.

As always, follow your doctor's instructions when taking Clomid, and don't be shy about asking questions before, during, or after treatment.

the clomid cycle
Verywell / Jessica Olah

Cycle Day 1: Your Period Begins

Your doctor may tell you that your official day one is the day after your period started. It depends on what time of day your flow began.

Day one is typically considered full flow (bright red) before 9pm. If bleeding occurs after 9pm or overnight, then day one is considered the next day.

Write this date down. You will need to take Clomid on particular days of your cycle. You may also need to have certain tests done on specific days.

If you only have spotting, call your doctor's office. You might never get a full flow. Your doctor can review your bloodwork to see where in your cycle you are.

If you have irregular periods or you don't get a period, your doctor can perform a "random start." They will check your bloodwork to see whether you are baseline for Clomid start or not.

If you have irregular periods, your doctor might prescribe the medication Provera (medroxyprogesterone), a form of progesterone. When you take this medication, it will induce a period. Your doctor might want you to take a beta pregnancy test (via blood work) to ensure you're not pregnant.

Tracking Your Cycle

To make the cycle easier to track, you can mark on a personal calendar the days of your cycle alongside the calendar dates. For example, if you start your period on April 3rd, write a "1" April 3rd, a "2" on April 4th, a "3" on April 5th, and so on.

Cycle Days 2–3: Baseline Ultrasound

When you call your doctor on the first day of your cycle, you may be asked to schedule a baseline ultrasound check. This is more likely to be done by a fertility specialist. The ultrasound appointment is quick and will be done transvaginally. A transvaginal ultrasound is done with an ultrasound probe via your vagina.

Your doctor is looking for cysts on the ovaries, not to be confused with the tiny cysts one might see with polycystic ovaries. In this case, the doctor is looking for a larger cyst. Usually, the ultrasound doesn't find anything. If everything looks good, your cycle can go on as planned.

If the ultrasound shows that you have a cyst, your doctor will likely cancel this cycle. You may need to wait until next month to try again. If they do find a cyst, don't worry. These cysts are rarely harmful and will usually disappear on their own. The main downside is you'll have to wait another month to start treatment.

As always, ask your doctor if you are concerned.

Cycle Days 3–5: Start Clomid

Once you've been cleared by your doctor, you'll take your first dose of Clomid on the day your doctor has instructed. You'll take one dose every day for five days, but you won't take any Clomid on the first day of your cycle.

Your doctor may tell you to take the Clomid pills on one of the following sequences:

  • On cycle days 3, 4, 5, 6, and 7
  • On cycle days 5, 6, 7, 8, and 9

Some doctors will have you start treatment on cycle day 2 or cycle day 4, though this is less common. There doesn't seem to be a difference in pregnancy success between beginning Clomid on day 3 or day 5. Different doctors prefer to use different protocols.

In some cases, your doctor may ask you to change the start day on your next cycle, to see if it'll make a difference for you. Ideally, take the Clomid at the same time every day. Some say that taking the pill before bed can help you sleep through some of the side effects. Others do better if they take the pill in the morning.

If you have another Clomid cycle, you can try taking it at a different time of day, but don't change the time of day once you start the cycle unless you speak to your doctor.

Cycle Days 3–9: Clomid Begins to Work

You won't ovulate on the five days you're taking Clomid pills. However, with your first dose, Clomid begins a chain reaction that will eventually lead to ovulation.

In short, the hormone FSH (follicle-stimulating hormone) signals the ovaries to grow and mature eggs (encased in follicles of fluid) to be released via ovulation. As the follicles on the ovaries grow, they release estrogen. The increase in estrogen signals the brain to slow down the production of FSH. This, in turn, slows down the stimulation of the ovaries.

Clomid works by tricking the brain into thinking your estrogen levels are unusually low. It does this by blocking estrogen from binding to its receptor. So, although estrogen is circulating in your bloodstream, the receptors are unable to detect it.

Thinking there are no growing follicles since estrogen appears to be low, your body responds by releasing more gonadotropin-releasing hormone (GnRH). GnRH then signals your pituitary gland to produce more FSH and LH (luteinizing hormone). The higher levels of FSH stimulate the ovaries, and the higher levels of LH eventually trigger ovulation.

Even though you take Clomid for only five days, the chain reaction that starts with your first pill continues throughout the month. This is one reason why you may continue to experience some side effects days after you take your last dose.

Cycle Days 10–21: Monitor Follicular Growth

Beyond suggesting that you use an ovulation predictor kit so you can time intercourse for your most fertile days, most gynecologists don't carefully monitor Clomid treatment cycles.

That said, many reproductive endocrinologists do. Fertility doctors monitor Clomid cycles for two primary reasons:

Monitoring the cycle usually starts a few days after your last Clomid pill is taken and may involve ultrasounds and blood work every few days until you ovulate. The ultrasound technician will measure the growing follicles, and your doctor will decide based on their growth when to time a trigger shot (if you're having one), an IUI, or intercourse for the cycle.

If two follicles develop to a mature size, your doctor may or may not advise you to skip the cycle. Two large follicles raise your odds for conceiving twins, but it's not guaranteed. Tell your doctor if it's important to you to avoid conceiving twins, so they can better advise you on what to do.

If three or more follicles mature, your doctor will likely cancel the cycle, meaning you'll be asked not to have sex (to avoid conceiving). And if an IUI or trigger shot was planned, neither will be given to avoid a higher multiple pregnancy, which carries serious risks to you and your future babies.

If your cycle is canceled, as tempting as it may be to ignore your doc and have sex anyway, you should take your doctor's warnings seriously. It may be a good sign that your body reacts to Clomid so sensitively. Hopefully, next time your doctor can adjust your treatment so as not to stimulate as many eggs. It's better to wait until next time than end up with a high-risk pregnancy.

Cycle Days 15–25: Trigger Shot

If you're seeing a fertility specialist, they may prescribe an injection of the hormone human chorionic gonadotropin (hCG) in addition to Clomid—also known as a "trigger shot." It's called a trigger shot because it triggers ovulation to occur within 24 to 36 hours. Your doctor may order a trigger shot to help better time for IUI or intercourse or to give your ovaries a little extra boost.

You may have heard of hCG (the pregnancy hormone) when reading about pregnancy tests. In the body, hCG acts a lot like LH, which is the hormone that peaks just before ovulation and signals the follicles to rupture and release an egg.

The trigger shot is usually given 7 to 9 days after your last Clomid pill, but it may be given later than this if ultrasound monitoring finds that your follicles need more time to mature before getting kicked out of their cozy follicle beds.

Important Note

If you are given a trigger shot, be aware that a pregnancy test taken within a week afterward may register as positive, even if you're not pregnant. The test will just be picking up on the hormones given via the injection.

Cycle Days 10–17: Timed Intercourse/IUI and Ovulation

Ovulation typically occurs 5 to 10 days after taking the last Clomid pill. So if you took Clomid on days 3 to 7 of your cycle, you are most likely to ovulate between days 10 and 16. If you took Clomid on days 5 through 9, ovulation is most likely to occur between days 12 and 17 of your cycle.

Ovulation can, however, occur even later than 10 days after your last Clomid pill, so it's something to keep in mind. If you were given a trigger shot, then ovulation will occur 24 to 36 hours after the injection.

Unless your doctor tells you otherwise, you should begin having sex every other day or every day, starting three days after you take your last Clomid pill. You should continue having sex until you've confirmed that ovulation occurred. You may get confirmation from a body basal temperature (BBT) chart or a progesterone blood test (given on day 21 of the cycle).

Are you doing an IUI cycle? Based on your ultrasounds and the timing of your trigger shot, your doctor will tell you when to come in for the IUI. In most cases, you can also have sex on your fertile days at home in addition to your IUI. (Think of it as extra credit!)

Cycle Days 19 or 21: Progesterone Blood Test

Both gynecologists and fertility specialists typically order a progesterone blood test sometime between days 19 and 21, though it may be given later if your doctor knows you have ovulated later than day 21 of your cycle.

Progesterone is a hormone that rises after ovulation, and testing for it can confirm whether or not Clomid triggered ovulation. Another reason for testing progesterone levels is to ensure levels aren't too low. If they are, your doctor may order a progesterone vaginal suppository as a supplement.

Cycle Days 21–35: The 2 Week Wait

The two-week wait begins after you ovulate and ends either with a positive pregnancy test or your period. This is probably the hardest part of the cycle to endure. All you can do is wait and see if the cycle worked.

During the two-week wait, you may experience mild symptoms of ovarian hyperstimulation syndrome (OHSS). The most common symptom of OHSS is bloating. A severe case is rare when taking Clomid, but it can occur. Be sure to contact your doctor if your symptoms are severe or if you're concerned.

Note: Some women confuse the bloating from the Clomid-stimulated ovaries as an early pregnancy symptom, when in fact it isn't. Remember that some of the side effects of Clomid can mimic "pregnancy symptoms," and try to remember that feeling pregnant doesn't mean you are pregnant.

Cycle Days 28 and 35: Pregnancy Test

Finally, the day you waited for all month: pregnancy test day.

Your doctor may order a beta pregnancy test (a blood test that measures the quantity of hCG) in the middle of your two-week wait and at the end, or they may order blood work only at the end. It's also possible they will simply ask you to take an at-home pregnancy test sometime between days 28 and 35 of your cycle and instruct you to call if you get a positive result.

If the test is positive, congratulations! Your doctor will likely monitor the pregnancy for a few weeks to be sure everything is going smoothly, and to check if you've conceived twins (or more). If you're feeling more nervous than excited, be reassured that it's normal. Pregnancy after infertility isn't always easy, especially emotionally.

What Happens If the Clomid Cycle Fails

If your pregnancy test is negative, your doctor may wait and retest you again. It's possible the pregnancy hormone levels just aren't high enough yet. If you get your period while waiting to test again, the cycle probably didn't work.

Having an unsuccessful cycle can be upsetting, and it's common to feel defeated and lose some hope. Remember that you can try again and that sometimes treatment needs adjustments before you reach success.

What happens after a failed Clomid cycle? Every case will be different, but here are some possibilities.

Another cycle of Clomid at the same dose you just used. Just because the cycle didn’t lead to pregnancy doesn’t necessarily mean anything about your treatment should be adjusted right away. You just might need another try or two.

Remember that even people with good fertility rarely conceive the first cycle they try. The same could be said about Clomid or any fertility treatment.

If you didn’t ovulate, another cycle of Clomid at a higher dose. The first cycle of Clomid is typically started at 50mg, but many women won’t ovulate at that dosage. If this happens to you, the dosage may be increased.

Your doctor will probably keep trying higher dosage levels up until a certain point, after which other treatments might be considered. Women who don’t ovulate on Clomid are sometimes called Clomid resistant. There are a variety of options if this happens to you, including switching to the drug letrozole or taking Clomid along with metformin.

If three to six cycles of Clomid don’t lead to pregnancy, new treatment options may be considered. Six cycles of Clomid is considered to be the top limit, though some doctors suggest moving on if pregnancy doesn’t occur by the third treatment cycle.

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2 Sources
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  1. American Society for Reproductive Medicine. Medications for Inducing Ovulation: A Guide for Patients.

  2. US Food & Drug Administration. CLOMID® (clomiphene citrate tablets USP).