Clomiphene Citrate and Letrozole are drugs taken by mouth that assist your body in growing at least one egg each month, sometimes even two or three. If you are currently unable to grow one mature egg each month, the drugs would be used with a goal of growing one egg. If you are currently able to grow and ovulate one egg each month, then the drugs would be used with the goal of growing two to three eggs each month. More targets, or more mature eggs for the sperm create more opportunities to get pregnant.

• Day 1: (First day of bright red bleeding from your vagina). Call us at 824-0075 to schedule an appointment for your Day 11 ultrasound.
• Day 3 through Day 7: Take _____ milligrams (mg) (_____ Pills) of _____________
• Day 8 through Day 12: Take _____ milligrams (mg) ( _____Pills) of estrogen (Estrace®). This will help to thicken the uterine lining.
• Day 11: Clinic visit for a vaginal ultrasound

We can measure the thickness of the uterine lining at this time. We will also count all of your mature eggs or those eggs we expect to “drop” from the ovary. Most women grow no more than two or three eggs with the use of Clomid® or Femara®

Based upon the results of the ultrasound, we might ask you to test ovulation kits for a few days or to take an injection called ovidrel which will allow the release of the mature egg or eggs. We will discuss this with you during this visit.

Side Effects
Both Clomid® and Femara® can affect your mood and can cause headaches and hot flashes. Estrace® can also cause mood swings, but to a much lesser degree.

Risks

1. Blood clots are a rare risk with Estrace® Call immediately if you experience:
   • Pain or swelling of legs or arms
   • Shortness of breath
     
2. Blood vessel spasms in your eyes are a risk with Clomid® . Call immediately if you experience any visual changes.  No long-term side effects will exist as long as you discontinue use of Clomid® right away.
   
3. Multiple Births: You have a risk of twins, as high as 8% per cycle if you do become pregnant. There is a very small (<1%) chance of triplets as well. The more mature eggs you grow each month, the higher your chance of twins or triplets.

Next Steps If Medication Is Ineffective
If Clomid® doesn’t appear to be working with your body; you will have the chance to try Femara®, or vice versa. We can also try increase the dose of either drug to see if your body has a better reaction. If neither of the drugs appears to work, injectable drugs are another method to try. Although injectable drugs are a lot stronger, they are also more expensive and time consuming than the drugs you take by mouth.

When to Call the Doctor

Call immediately if you experience:

• Pain or swelling of legs or arms
• Shortness of breath
• Cramping lasting longer than one hour
• Bleeding that fills more than one pad per hour
• Fever of 100°F or higher or chills
• Visual changes