Introduction

1. Introduction QUICK START: Timed Intercourse or Intrauterine Insemination with CLOMID or LETROZOLE

2. Prior to beginning your cycle, you must have: • Completed your checklist • Signed all consents • Obtained all of your medication for your cycle • Checked with your financial coordinator that you are financially cleared for your cycle. You will not be allowed to start any medication if you are not financially cleared.

3. Ovulation • Women with regular menstrual cycles are normally ovulate just one egg a month. • The menstrual cycle is regulated by the pituitary gland. This gland sends two signals to the ovary called Follicle Stimulating Hormone or FSH and Luteinizing Hormone or LH. These two hormones encourage egg development and trigger ovulation. • Some women do not release enough FSH to encourage egg development. Introduction

4. Ovulation Ovulation

5. CLOMID CLOMID Clomid (clomiphene citrate) is a medication that tricks the brain and pituitary gland into releasing more FSH in order to stimulate follicle development and encourage ovulation.

6. LETROZOLE Letrozole (Femara) Enhances the brain’s ability to produce FSH to stimulate the ovary LETROZOLE

7. CLOMID/LETROZOLE • Clomid and Letrozole are best used in patients without regular menstrual cycles to induce ovulation. • Clomid and Letrozole have been used for other infertility diagnoses, particularly when patients do not want to use more aggressive therapies due to cost or risk. CLOMID/ LETROZOLE

8. Monitoring • Clomid or Letrozole are usually taken for five days starting on the 3rd, 4th or 5th day of menses. Your doctor may prescribe one, two or three pills a night. • Your nurse will advise you what day to come return to the office during morning monitoring for blood work and an ultrasound. Monitoring

9. Monitoring • If the monitoring physician determines you are almost ovulating or ovulating, you will be instructed to have intercourse or make appointments for intrauterine inseminations (IUI) over the next two days. • Please note Clomid/Femara cycles are enhanced with an Ovidrel injection (hCG) for ovulation timing purposes. hCG also known as human chorionic gonadotropin, is a hormone, which when injected, stimulates ovulation to occur. Monitoring Click here to view our Injectable Medication Training Videos

10. Monitoring Intrauterine Insemination Intrauterine insemination, or IUI is a procedure that places washed sperm directly into a woman’s uterus around the time of ovulation. This may improve a woman’s chance of getting pregnant because more sperm will make their way closer to the egg.

11. Potential Side Effects • Hot flashes, cramping, mood swings, headaches • Stop medication for severe headache or visual disturbances • Multiple pregnancy • Thin Uterine Lining • Ovarian Twisting (torsion) • Ovarian Hyperstimulation Syndrome Side Effects

12. Questions