Clomiphene is usually started day 2 to 5 of a cycle with a negative pregnancy test .  Do a pregnancy test before starting clomiphene even if your period seems normal.  There is a possibility of birth defects if clomiphene is taken while you are pregnant and possibly if taken the month before or for multiple cycles.

Take one prenatal vitamin every day all the time. Increase to 5 mg of folic acid daily anytime you might be pregnant and until you are 8 weeks pregnant to decrease the chance of birth defects.  Days 14 to 30 days after ovulation are the most important

An exam or ultrasound (sonogram) can be done before starting clomiphene when there is pain, fullness, or pelvic discomfort to check for a cyst.  If there is a cyst, clomiphene is stopped until the cyst goes away.

Ovulation tests and ovulation monitors are commonly used for timing sex.  Clomiphene can cause false positive ovulation tests.  Start testing 3 days after finishing clomiphene. 

85% of all pregnancies occur in the first three ovulatory cycles.  If you are not pregnant in three to six ovulatory cycles, further evaluation or more intensive techniques such as Pergonal, artificial insemination, or in vitro fertilization can be considered.

Mood swings and hot flashes are common.

 Patients seeing Dr. Martin have had one set of quadruplets, five sets of triplets, and uncounted number of twins on clomiphene in 30 years.

Ovarian cysts may cause pressure, pain or fullness; you should be checked if any one of these occur.  On rare occasion, these can require hospitalization.

There is a possibility of birth defects if clomiphene is taken while you are pregnant, shortly before you are pregnant or for multiple cycles.  Use pregnancy tests before starting clomiphene, even if you had a period.  Symptoms of pregnancy include breast tenderness, nausea and pelvic fullness. 

There is concern of cancer in patients with infertility, endometriosis, tubal adhesions and ovulation problems.  Although clomiphene may not increase the chance of cancer, it can delay diagnosis if exams, ultrasound, biopsy or D&C are delayed.  Women who have no children should be monitored closely, particularly at age 40 to 60, for evidence of cancer.  Additional information is in the references of  the Clomiphene PDF.

Interfere with sperm and mucus interaction,

Decrease the growth of the uterine lining and decrease success.  Sonograms may be useful in determining this.

Interfere with hormones that control ovulation, conception, and growth.

Decrease fertility with inseminations for male problems.

Downloadable Clomiphene PDF with additional information

http://www.fertilitylifelines.com/initialtreatments/clomiphenecitrate/how.jsp

http://www.ivf.com/clom.html has clomiphene and letrozole information