Sometimes physicians will prescribe Clomid as a first line “trial” therapy without fertility testing of either partner. This plan is fine provided that the treatment with Clomid is confined to a few months. If Clomid is unsuccessful after a few months, Dr Bachus would generally recommend that a more thorough evaluation of both partners be performed to include at least a semen analysis and perhaps an ultrasound and hysterosalpingogram (HSG) study to be sure that the tubes are open.
Once Dr. Bachus identifies the cause(s) of infertility, appropriate therapies will be prescribed.
Dr. Bachus sometimes recommends transvaginal ultrasound monitoring of follicular development for Clomid patients. This allows him to assess the number and size of the follicles and to document ovulation. Some patients have poor or absent ovulation despite what appears to be normal egg development. By appropriately monitoring the dynamics of egg development with the ultrasound, ovulation can be “controlled” by the administration of a simple medication called hCG.
This medication induces ovulation in the same manner as naturally occurs by the hormone called LH. By administering hCG when the follicle is mature, ovulation can be more certain and the timing of intercourse can be more accurately determined. This simple method of treatment has resulted in many pregnancies, and has the advantage of being able to conceive at home.
The next step after the failure of Clomid alone to achieve a pregnancy is usually to combine Clomid with another stronger ovarian stimulation medication called FSH. Ultrasound monitoring along with hCG administration is then combined with intrauterine inseminations (IUIs). Sometimes FSH alone without Clomid or even in vitro fertilization (IVF) is a better option. Each couple is unique and treatments vary for a variety of reasons.
Studies demonstrate that Clomid is most likely to be effective within three to six ovulatory cycles and pregnancies beyond six cycles are uncommon. Yet, we often see patients who have been on Clomid for as long as a year without additional evaluation. This is probably not ideal, and is even more important not to delay further workup after 3-6 months of unsuccessful Clomid therapy in individuals beyond 35 years of age, or those with a limited number of eggs as determined by ultrasound.
In these individuals, time may be of greater importance and more aggressive therapies more appropriate. An infertility specialist is of even greater importance in these individuals.