I found your website from someone who posted about it on the bulleting boards and I can’t stop reading it!
I took Clomid once and it made me ovulate but not get pregnant. My doctors says that it was successful because before Clomid I didn’t even ovulate. She told me that the chance of getting pregnant each time I ovulate is 20%. Why is it only 20% and what can I do to make it 100%? Does that make sense?

ROBERTA, Alabama

Dear Roberta,

Clomid works its very best when it is given to women who normally do not ovulate on their own, but then end up ovulating while on the Clomid. It is not as helpful when given to women who already ovulate on their own. Remember that the average woman with normal fertility does not always get pregnant every single month. In fact, the monthly odds of getting pregnant are about 20-25%. If you are a woman who does NOT ovulate on your own, but is fortunate enough to respond to Clomid, then it is an approximate, but fair estimate that the Clomid now has converted you from having zero chance of pregnancy that month (had you not ovulated) to having a normal chance, provided that the sperm and tubes do not contribute any problems, and that normal chance is about 20-25% in most cases.

The question of why normal fertile women or women who respond to Clomid do not have a 100% chance of conceiving with each ovulation is a good one.

One way to look at it is to realize that few things in life are 100%. This is not purely a philosophical answer, but rather one based on reality. If you have normal vision, normal hand-eye coordination and normal arm strength, then you have the capability to wad up a piece of paper and throw it into the wastepaper basket across the room. You can probably succeed on a fairly regular basis, tossing it in every few tries, but you can NOT do it 100% of the time.

Now let’s consider what has to happen in order to get a successful conception. First of all, you must have ovulation. But even assuming that you do ovulate, the egg, which explodes out of the ovary into the general area of the Fallopian tube now has to be lucky enough to be scooped up by the tube. This does not always happen. On my old blog, I posted a description of how egg pickup by the tubes can be compared to the actions of a swimming pool sweeper. So, if the egg is successfully picked up, then it may or may not encounter a sperm. Even if sex occurs within the correct window period, the egg is microscopic and the few sperm that reach its general neighborhood may still not collide with it. Even if the sperm does hit the egg, it may not have the strength left, so to speak, to successfully fertilize it. And even if the sperm and egg do result in a fertilized embryo, that particular sperm or that particular egg may not have perfectly normal DNA. Without perfectly normal DNA, the embryo will stop growing and fail to implant. With all that can go wrong, it is a wonder that pregnancy occurs naturally at all, but it does. And it does so about 20-25% of the time.

Your doctor is on the right track. However, if you still don’t get pregnant after ovulating several times on the Clomid, then it’s time to look at stronger ways of getting the job done, such as IUI or even IVF. Remember that even though something is only 20% and not 100%, if it’s done enough times it will eventually succeed. Thank you for your question. 

Hello!  Your website is great.  It is so informative and helpful.  i was
wondering if you could give me some insight……

KIM, North Carolina

Dear Kim,

Let’s look at the big picture. It has been nine months since you went off the OCPs. While we would love it if you had regular ovulatory cycles, the harsh fact, based on the detailed information that you provide about your cycles,  is that you don’t , at least not on a consistent basis.  Your RE has chosen Clomid as the first line treatment for you. Let’s assume that you have had your thyroid and prolactin checked already. The goal is straighforward at present. GIVE CLOMID. MONITOR to see if ovulation occurs.

I have to admit I don’t quite understand what the 45 and 55 mean. I can’t imagine that your RE counted 45 and 55 small follicles in your ovaries. I’m wondering if you meant that he saw a very large 45mm follicle. That wouldn’t quite make sense either, because if you had 45mm and 55mm follicles, your E2 (estradiol) would be expected to be higher than 69 pg/ml. In any case, to answer your specific questions, some RE’s will start patients on Clomid and if there is no response, they will add injectables. I have never tried to give a higher dose of Clomid within the same cycle. It doesn’t mean that it won’t work, but time will tell. Again, it’s a good thing that you are being monitored so we will at least know what’s going on.

As for what the chances are that it will make you ovulate, at this point, the decision has already been made, so we should just be patient and see what the monitoring shows. After something is done and committed, I try to minimize thinking about what the chances are, but instead focus on carefully tracking what DOES happen. Having said that, I’ll venture a guess that someone who does nothing on Clomid 100mg, will probably not do much on Clomid 150mg givin within the same cycle.

As for whether or not you have PCOS, the smartest things would be to get more information before answering that. There are several questions I need to know before venturing an opinion. I will agree with you that you being so slender would make it atypical for you to have it. BUT there are exceptions. If you haven’t already read this story, you might find it interesting.

So what if Clomid doesn’t work? Your RE knows more about you than I do, so I would defer to him/her. My general approach is to start with some investigation into the causes of the poor ovulation. This starts out with better understading the patients lifestyle (nutrition, stress level, exercise, overall wellness). This might then include checking TSH, prolactin and insulin resistance. Another factor that influences the choice of letrozole vs injectables is the patient’s preference. Is this someone who begs to avoid needles if at all possible and wants to go as conservatively as she can? Or is this someone who is determined to get pregnant as quickly as possible? Most of my patients go on to injectables rather than try letrozole.

Thanks for the question. Feel free to leave a comment with an update on your story. Good luck!

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