Medicated Cycles
Letrozole, clomid, metformin, trigger shots and progesterone support. Doses, success rates, side effects, and timing. Doctor-led, evidence-led.
The posts to read first.
20 min readClomid: How It Works and Why It's Used Less for PCOS Now
Clomid explained by an OB/GYN: how clomiphene citrate triggers ovulation, why letrozole replaced clomid for PCOS first-line after the 2014 PALO trial.
21 min readFollicle Tracking Ultrasounds: What You'll See and Hear
What a follicle scan measures, what each number means, and what to expect from a transvaginal ultrasound during a letrozole or clomid cycle.
21 min readThe HCG Trigger Shot: What It Does and Why You Take It
Is Ovidrel a trigger shot? An OB/GYN explains what the hCG trigger does, when ovulation happens, the 36 to 40 hour timeline, side effects, and what to track.
21 min readLetrozole for PCOS: How It Works and Why It's First-Line
Letrozole with PCOS, explained by an OB/GYN: why it became first-line after the PALO trial, how aromatase inhibition works, dose, cycle 1 expectations.
23 min readMetformin for PCOS Fertility: How It Helps and When to Start
Is metformin for PCOS the right fertility step? An OB/GYN explains how it works, who benefits, when to start, and what the evidence says about pregnancy.
27 min readPartner Through Medicated Cycles: Injections and Showing Up
A doctor's guide for partners through medicated cycles: drawing up injections, clomid for men side effects, red flags, and what to actually own.
21 min readProgesterone in the Luteal Phase: Tests, Targets, Supplementation
What day-21 progesterone actually measures, what's normal, and when supplementation makes sense after ovulation induction or in pregnancy. By Dr. Rumpa.
Or pick a corner.
Clomid (Clomiphene)
2 posts
15 min readClomid Side Effects: What to Expect and What to Call About
Clomid side effects in women: real frequencies, the one symptom that always warrants a same-day call to your clinic, and practical workarounds from an OB/GYN.
17 min readClomid vs Letrozole: Which One and Why
Clomid vs letrozole, compared by an OB/GYN: PALO trial outcomes, side effects, lining, multiples, and the specific cases where each drug still wins.
Follicle Monitoring
2 posts
16 min readHow Big Should a Follicle Be Before Trigger
The ideal follicle size for a trigger shot is 18 to 22mm. Here's why that range matters, when REs flex it, and what to ask if your scan is borderline.
17 min readMultiple Follicles on Letrozole: Risk, Reward, and Twins
Letrozole and twins, by the numbers: a 3 to 4 percent twin rate, how multiple follicles change the cycle plan, and what cancel thresholds look like.
Letrozole (Femara)
3 posts
13 min readWhat to Expect from Letrozole Cycle 2 and Beyond
Letrozole cycle 2 in PCOS: what your RE learned from cycle 1, what may change, what stays the same, and the data to review before day 3. By an OB/GYN.
14 min readLetrozole Didn't Work: Dose Increase or Switch
When to increase letrozole dose vs switch: three 'letrozole didn't work' routes (no ovulation, no conception, chemical) and what's next. By an OB/GYN.
13 min readLetrozole Success Rates by Age, PCOS Status, and Cycle Count
Letrozole success rate per cycle and cumulative live birth: PALO trial numbers, age effects, BMI, PCOS vs unexplained, and when to step up. By an OB/GYN.
Metformin for PCOS
1 post
17 min readMetformin Dose for PCOS: 500mg, 1000mg, 1500mg Explained
Metformin 500 mg for PCOS weight loss is rarely the final dose. An OB/GYN walks through the titration ladder from 500mg to 2000mg and what each level does.
Progesterone Support
1 post
16 min readWhen Doctors Prescribe Progesterone After Ovulation Induction
When to start progesterone after a trigger shot, why REs prescribe it after IUI, and what the evidence really shows in oral-medication cycles.
Trigger Shot
1 post
15 min readOvidrel: Side Effects, Timing, and What to Expect
Ovidrel explained by an OB/GYN: how to inject, common side effects, when symptoms start, OHSS warning signs, and what to do in the 36 hours after the shot.
A note from Dr. Rumpa.
Ovulation induction with oral agents is the workhorse of fertility medicine, and the letrozole success rate, the clomid vs letrozole comparison, and the metformin protocol decide whether a medicated cycle is worth doing before IUI or IVF. This journey covers the full arc with the doses, monitoring, and numbers a reproductive endocrinologist would quote in clinic.
Start with the drugs. How clomid works, why it is used less for PCOS now, and what changes when switching from clomid to letrozole. Letrozole with PCOS as first-line therapy, the 2.5mg, 5mg, and 7.5mg dose ladder, when to increase letrozole dose, and the letrozole side effects worth flagging. Cycle 2 expectations, the letrozole success rate by age and PCOS status, and the letrozole and twins risk that multiple follicles drive.
Then the PCOS combination protocol. Metformin for PCOS fertility, dose tiers from 500mg to 1500mg, surviving the metformin GI side effects, the metformin and letrozole pcos combo, and stopping metformin once pregnant.
Monitoring and triggers. The follicle scan walkthrough, the ideal follicle size for trigger shot, the hcg trigger shot and ovidrel, lupron vs hcg trigger, trigger shot timing for sex or IUI, and the trigger shot pregnancy test false positive window.
Finally, luteal phase support. When to start progesterone after trigger shot, luteal phase progesterone targets, and the suppositories vs pills vs injections decision.
Just the numbers, the doses, and the decision points.
Keep moving.
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