For treatments using Clomid and IUI, only a couple of office visits per month are required. Clomid is usually prescribed at doses of 50–100 mg daily taken on cycle days 5–9. We typically have patients begin monitoring on cycle day 12 (Letrozole is now used more widely than Clomid. Read about letrozole here). At a typical office visit for monitoring, the patient has her blood drawn for hormone analysis, and a pelvic ultrasound is performed to measure the size of the follicles and the thickness of the endometrial lining. The doctor uses this information to determine the optimal timing of the HCG trigger shot and the subsequent IUI. Most patients receive the HCG trigger injection once the follicle size is >20–22 mm mean diameter. This trigger shot will induce ovulation around 36–40 hours later so the IUI is scheduled accordingly or the couple is informed of the best timing for intercourse. Occasionally a patient will demonstrate an LH surge on her own and the timing of the IUI or coitus should take this into account.
For treatment using gonadotropins and IUI, closer monitoring is necessary, perhaps requiring 4 to 6 office visits per treatment cycle. Patients in our practice undergo a baseline sonogram on cycle days 2 or 3 to rule out any persistent ovarian cysts from the preceding treatment cycle. If the sonogram is normal, then patients begin the daily injections and usually return to the office after 3–4 days of medication to assess the response to the drugs. Adjustments in the dose of the medications may allow for the optimal treatment response and most patients require 10–12 days of shots before the follicles reach the ideal size. Once again, the HCG trigger shot is used to induce ovulation at the appropriate time and the IUI is scheduled accordingly. The actual IUI takes only minutes to perform and is usually painless. We routinely ask our patients to lie on their backs for about 10 to 15 minutes following the IUI procedure. The woman may then return to her normal activities. In couples pursuing timed intercourse, a pregnancy test is performed, usually 14 days following an IUI or 16 days following HCG.