How does CC work?
Normally each month the pituitary gland at the base of the brain makes enough follicle stimulating hormone (FSH) to allow one egg to grow in the ovaries. For women with ovulation disorders, the amount of FSH is inadequate to promote egg growth. This can occur for a number of reasons. The most common reason is being overweight. Even though a normal amount of FSH is secreted in overweight women, the extra weight absorbs or dilutes the amount of FSH that the ovaries receive and the signal to the ovaries is weakened. CC makes the brain secrete more FSH early in the cycle so the ovaries will hopefully get enough to promote egg growth. Even if being overweight is not your problem, CC works in the same way.

Who should take CC?
CC works best in women with ovulation disorders including those with polycystic ovarian syndrome (PCOS). Over 75% of PCOS women will ovulate with CC and about half of these women will conceive. Another group of women who may benefit are those who ovulate but have low progesterone levels. For couples with unexplained infertility, CC may help subtle ovulation problems, increase progesterone levels, or grow 2 or more eggs, any of which may help a couple to conceive.

How do I take CC?
For most women, you will be instructed to take 5 days of CC beginning within the first few days of your menstrual cycle. The number of pills each day may vary each cycle depending on many factors. Generally, the lowest dose necessary to achieve ovulation is the best dose. For unexplained infertility, the usual dose is 2 pills/day for 5 days. If your dose is 2 or more pills each day, take the pills at one time. Do not spread them out through the day. There are no requirements for eating or drinking with the pills.

How do I know if CC is working?
If you are taking CC for ovulation disorders, your medical provider will check a progesterone level about a week after ovulation. If the progesterone level is adequate and you are not pregnant, you will continue on that dose. If the progesterone level is too low, your dose will generally increase by one pill/day until a maximum of 3 pills/day is reached. If no ovulation happens at that dose or you do not get pregnant, your provider will generally recommend moving to another intervention.

How can I get best results using CC?
CC is a powerful medication that requires careful attention to your cycle. It is important to have sexual intercourse at least 3 times in the week of expected ovulation. Most women taking CC will ovulate between days 13 and 17 of their cycle. Generally sexual intercourse is recommended every other day starting on day 12 of the cycle. Your provider will tell you if this may be different. If your provider asks you to get a blood test on certain days of your cycle be sure to get these tests done on those days. Once you are taking the right dose of CC for ovulation, you may wish to purchase and use a urine ovulation prediction kit that will tell you the best days to have sexual intercourse for pregnancy.

What are the side effects of CC?
The most dangerous side effect is visual problems that are noticed by about 1 in 20 women. These may be blurry or double vision or colorful spots of light. If you experience any of these, do not take any more CC and call your provider. About half of women taking CC will experience some hot flushes lasting about 1 to 3 minutes at any time during the day. These usually occur while you are taking the medicine and should be gone within a few days after your last dose. Also about half of women taking CC will have some mood changes. There are some medical studies that report an association between long-term use of CC and some gynecologic cancers. To minimize these risks, your provider will limit the number of CC cycles.

Who should not take CC?
CC is not recommended for couples where there is an abnormal semen analysis, for women with a history of liver disorders, those with elevated FSH or estradiol levels and those with blocked tubes.