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Clomiphene is a drug that interferes in the feedback mechanism to the way the body measures its own oestrogen level. In short it tricks the body into thinking that the oestrogen level is too low so the body drives the ovary harder to release an egg that cycle. Clomiphene has a particular risk which is the risk of multiple pregnancy, so we start the medication in very low dose. We gradually, cycle by cycle, increase the dose until we get you ovulating. This minimises the risk of multiple pregnancy but there is still probably around a one in twenty risk of twins.
The normal protocol is to start you on 1/2 a tablet a day and you take it for 5 days in the menstrual cycle. You can start on the first day of bleeding or somewhat later. Many people do start on the first day of bleeding but I prefer to leave it until day three. If Clomiphene is taken while you are already pregnant then it can cause fetal abnormalities and by the third day of bleeding most women are sure that it really is a period and not a little bit of bleeding early in a pregnancy. If there is ever any doubt then we get a blood pregnancy test performed before you take the Clomiphene that cycle. I suggest you start taking the first dose of Clomiphene on day three of bleeding and then take it for five days only.
In the normal pattern of events you should ovulate around day 14 of that cycle and then menstrual around day 28 if you have ovulated. If you ovulate there will be progesterone circulation and we can test this on day 21. If the progesterone is positive in good level then the next cycle we repeat the same dose. If the progesterone is not positive with the next cycle we increase the dose to a full tablet. If that gets you ovulating we get you to stay on that dosage. If it does not we then progressively increase the dose until you are ovulating regularly.
Hope that's useful. As I said, Metformin re-established a cycle for me. I initally was put on Metformin with the intention of starting Clomid after 6 weeks. Apparently Metformin can help you respond better to the Clomid.