The majority of patients who are going to ovulate will do so after the first course of therapy. If ovulation does not occur after three courses of therapy, further treatment with Clomid is not recommended and the patient should be reevaluated. If three ovulatory responses occur, but pregnancy has not been achieved, further treatment is not recommended. If menses does not occur after an ovulatory response, the patient should be reevaluated. Long-term cyclic therapy is not recommended beyond a total of about six cycles (see PRECAUTIONS ).
An overnight dexamethasone suppression test should be performed in women with physical features of cortisol excess, such as hypertension, central obesity, facial plethora, easy bruising, striae, proximal muscle weakness and/or increased cervicodorsal-supra-clavicular fat. For this test, 1 mg of dexamethasone is administered orally at 11 ., and serum cortisol measurements are taken at 8 . the following morning. Serum cortisol levels below 5 μg per dL (140 nmol per L) make the diagnosis of Cushing's syndrome unlikely but are routinely present in women with polycystic ovary syndrome.