Do I need to have a period before starting Clomid?

 It may be OK to start clomid without a period.   

It may be possible to ovulate without a period.

For many couples suffering from infertility, the treatment journey starts with Clomid (clomiphene). These fertility pills help to stimulate ovulation, and when used properly, are safe and effective as a first line treatment for many couples.

One of the more frustrating parts of about taking Clomid is having to wait for a menstrual period to start the medications.

Traditionally, Clomid is started on the 3rd or 5th day of the menstrual cycle, and it is not uncommon for doctors to proscribe progesterone-like medication to bring on the period before starting fertility drugs. If you are seeing an obgyn physician for your fertility treatment and your cycles are irregular, this is likely what will happen.

It turns out it is no longer necessary to have a period in order to start fertility drugs.

Fertility specialists have adopted this new way of thinking after a article came out a few years ago, suggesting the having a period is not necessary in order for fertility pills to be successful.  Not only that, but the chances for success may even be lower if medications are used to bring on the period. This is referred to as the "stair step protocol." So, what does this mean?

The stair step protocol means less time to make you ovulate and a shorter time to conception.

So, why does my doctor not use clomiphene that way?

Most obgyn doctors have been trained to use Clomid in the traditional way. Fertility specialists tend to be more current on the latest treatments and more likely to offer the stair step.

Can the stair step be used with other fertility drugs?

In our practice, we routinely use letrozole (Femara) in place of clomiphene with the stair step and it works just fine. Injectable fertility drugs can also be started without a period, but those treatment cycles are different.

Does this mean we can start clomiphene at any time?

No. Your doctor will need to determine that you are not pregnant and did not ovulate already before starting fertility drugs. Using these drugs as the wrong time of the cycle can cause more harm than good.