Infertility/Fertility/PCOS from Nigeria


Dear Dr Ramirez, I am 31 and was diagnosed with PCOS in June 2013, I started on clomid 50 mg in dec 2013, I conceived that cycle (it was a text book cycle with ovulation bleed and ovulation on day 17) but had a miscarriage in feb 2014 at 8 weeks, my cycle started again on Apr 5 and no ovulation that cycle, I started a second cycle of clomid on May 31 but no ovulation and a 3rd cycle of clomid on July 2 ovulated on cycle day 26 and period started again on August 14, I have not been monitored during my clomid cycles, I do basal temp so I know when I ovulated. I told my doctor I was very worried about just taking another round of clomid when I have read the limit is 6 cycles, he said not to worry that its only my 4th round and I conceived on the first one so it does'nt really count. My cycles range from 35 days to a 100 days, my luteal phase is 16 days, PCOS was diagnosed after I got of the pill after 8 years on it, prior to the pill I had a clockwork 30 days cycle. Please advise me, apologies for the long post

Hello Ena from Nigeria,

The fact that you responded to low dose Clomid is a sign that your PCOD is not very bad and that is good.  However, because of the cycles where you did not stimulate, I would recommend increasing the dosage to 100 or 150 mg per day.

The reason it is recommended not to try more than 6 cycles is not because the Clomid might do harm but because your chances of pregnancy go down.  After 6 cycles, if no pregnancy has occurred, it is a sign that there is some other problem going on so the recommendation is either to do a comprehensive evaluation (if none has been done) or move to a higher level of treatment.  Once you get pregnant, the count starts all over again, and the fact that you got pregnant, despite having miscarriage, is proof that everything else is working.

If you read my blog regarding my preference for ovulation induction or Clomid cycles, you will see that I am more aggressive, whereas your doctor seems to be mostly hands off.  You might want to read the posts for your information and education.

My only recommendation is to NOT use Clomid in consecutive cycles because Clomid blocks vital estrogen receptors.  I would recommend alternating Clomid with Femara (Letrozole) which is given in 1-3 tablets per day just like Clomid.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at if you are interested in continuous access to me.


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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