How to Take Clomid and What to Expect During Treatment

Clomid Cycle Day 1: Your Period Begins

Pharmacist and customer discussing how to take Clomid
If you have any questions or concerns on how to take Clomid, be sure to talk to your doctor and pharmacist.. Caiaimage/Agnieszka Wozniak / Getty Images

How do you take Clomid 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 a number of 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 with 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.

Important note: As always, follow your doctor's instructions when taking Clomid.

Don't be shy about asking questions before, during, or after treatment.

Clomid Cycle Day 1: Your Period Begins

Your doctor will likely tell you to contact her office on the first day of your period.

(If you have irregular periods, your doctor may prescribe the medication Provera, a form of progesterone, to induce a period first.)

The first day of your period is the day you have a menstrual flow, and not just very light spotting.

If you're unsure if your period actually started, or if your bleeding is unusually light, ask your doctor. She may have you take a beta pregnancy test (via blood work) to ensure you're not pregnant.

Day One of your cycle is the first day of your period. However, just to be more confusing, 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. 

(This is one reason you may need to call your doc before you start treatment.)

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

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 on April 3rd you get your period, you'd write a 1 in a circle on April 3rd, a 2 in a circle on April 4th, and so on.

Clomid Cycle Day 2-3: Baseline Ultrasound Check

Transvaginal ultrasound probe.
Transvaginal ultrasounds are used during fertility treatment to check the ovaries before treatment, to make sure there are no cysts, and to assess follicle growth as the cycle progresses.. Photo: Matt Valentine / Shutterstock

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 with 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 finds a cyst or cysts, 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.

Clomid Cycle Day 3-5: Clomid Treatment Begins

Woman taking a pill.
Be sure to take your clomid at the same time every day.. Photo: wavebreakmedia / Shutterstock

Once you've been cleared by your doctor to start the cycle, 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 Cycle Days 3, 4, 5, 6, and 7, or
  • 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 starting 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.

Clomid Cycle Days 3-9: Clomid Begins to Work

The ovary and the stages of follicle development.
The ovary and the stages of follicle development.. Photo © A.D.A.M.

You won't ovulate on the five days you're actually taking Clomid. 

However, with your first dose, Clomid begins a chain reaction that will eventually lead to ovulation.

Read this article to get a more detailed explanation of how the female reproductive system works.

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. Estrogen is circulating in your blood stream, but 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, or GnRH.

GnRH signals your pituitary gland to produce more FSH and LH.

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.

Clomid Cycle Days 10 to 21: Monitoring the Follicles

Woman using an ovulation predictor kit.
Your doctor may recommend using an ovulation predictor kit or ovulation monitor so you can accurately time sex for pregnancy.. Photo: Alis Leonte / Shutterstock

Beyond suggesting that you use an ovulation predictor kit so you can time intercourse for your most fertile days, most gynecologists don't closely monitor Clomid treatment cycles, but many reproductive endocrinologists do. Fertility doctors monitor Clomid cycles for two primary reasons:

  • to keep an eye on how many follicles grow, so they can cancel the cycle if more than two (or more than one) appear
  • to time a trigger shot (explained in the next step) or an IUI - intrauterine insemination

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 she 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 in order to avoid a higher multiple pregnancy, which carries serious risks to you and your future babies.

If your cycle is canceled, as frustrating as this can be (and as tempting as it may be to ignore your doc and have sex anyway), you should take your doctor's warnings seriously. It's actually a good sign that your body reacts to Clomid so sensitively, and hopefully in the next cycle, 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.

Clomid Cycle Days 15 to 25: The Trigger Shot (Maybe)

Insulin injection
IAN HOOTON / Getty Images

If you're seeing a fertility specialist, he 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 an extra little boost.

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

The trigger shot is usually given seven to nine 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 afterwards may register as positive, even if you're not pregnant. The test will just be picking up on the hormones given via the injection.

Clomid Cycle Days 10 to 17: Clomid Sexy Time, Maybe IUI

Couple on couch flirting
Sex "on demand" during fertility treatments can be stressful. Don't make it all business -- have fun, too!. Photo: Cavan Images / Taxi / Getty Images

Ovulation typically occurs five 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, and continue having sex until you've confirmed that ovulation occurred. You may get confirmation from a body basal temperature chart or a progesterone blood test (usually 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!)

Clomid Cycle Day 19 or 21: Progesterone Blood Test

Vial of blood in a lab
Your doctor will likely order blood work for your two week wait, to see if you've ovulated.. Rafe Swan / Getty Images

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.

Clomid Cycle Days 12 – 35: The Dreaded Two Week Wait

We can get through this together
PeopleImages / Getty Images

The two-week wait begins after you ovulate and ends either with a positive pregnancy test (yay!) or your period (boo!). This is probably the hardest part of the cycle to endure, as 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. A serious 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.

Clomid Cycle Days 28 – 35: Pregnancy Test Day!

All smiles
CPO-Photography / Getty Images

Finally, the day you waited for all month: pregnancy test day! Your doctor may order a beta pregnancy test or a blood test that measures the quantity of hCG, in the middle of your two-week wait and at the end, or she may order blood work only at the end. It's also possible she 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.

If the test is negative, your doctor may wait and retest you again. It's possible the hormone levels aren't high enough yet. But if you get your period, 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.

More about Clomid:


Coughlan C, Fitzgerald J, Milne P, Wingfield M. "Is it safe to prescribe clomiphene citrate without ultrasound monitoring facilities?" J Obstet Gynaecol. 2010 May;30(4):393-6. doi: 10.3109/01443611003646280.

Medications for Inducing Ovulation. American Society for Reproductive Medicine. Accessed February 25, 2013.

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