Women who do not ovulate spontaneously and have normal estrogen levels are traditionally prescribed clomiphene citrate, also as known as Clomid. For women who don’t ovulate spontaneously, 80% will ovulate with clomiphene and 50% will conceive.

There are some disadvantages of using clomiphene, such as side effects like hot flashes, sensitivity to light, headaches, bloating and mood swings. Also, clomiphene citrate is associated with multiple follicle growth, so 20% of pregnancies that are the result of using Clomid may result in twins or even triplets. Additionally, sometimes a woman’s cervical mucus becomes drier and thicker on clomiphene, and occasionally the inside of the uterus doesn’t grow as thick as it should.

In recent years, other options that control hormone production, such as Letrozole (also known as Femara), have become increasingly popular for ovulation induction. Letrozole seems to have fewer side effects, is less likely to make multiple follicles, and is less likely to affect the cervix and endometrium to the degree that Clomid does. In comparison studies, Letrozole is as good as and maybe more effective than Clomid for inducing ovulation.

Both medicines are oral pills started between Day 2 and Day 5 in the menstrual cycle, and taken for five days after the start of a period. Dosage generally starts at one pill and can be increased in subsequent cycles to two pills or three pills as needed. Ovulation typically occurs one week after the last pill, but it may happen later than that. Dosage can vary based on a woman’s weight, testosterone levels and other factors.

If oral pills fail to induce ovulation, the next step is usually ovulation induction with injectable pituitary hormones. These shots are usually successful, but may produce multiple follicles. If there are too many follicles and the risk of multiple gestations becomes too high, then the cycle would need to be canceled or converted into an IVF cycle where all the eggs can be removed, and the fertility doctor and patient can control how many embryos are transferred back in.