Q: How is clomiphene usually given?

A: Success of clomiphene is simply defined as ovulation (followed by pregnancy). That makes it very important to check for ovulation as the first step in the success of clomiphene.

If a woman ovulates at the lowest dose, there is no advantage to increasing the dosage. Giving more clomiphene than necessary may make things worse, because this can lead to increased complications such as multiple ovulation, side effects such as an ovarian cyst or hot flashes, and most commonly, interfering with fertile mucus production.
If there is no ovulation after taking a lower dose, then the dose is usually increased by 50 mg a day (from 50 to 100 mg) in the next cycle, and if there is still no ovulation, then the daily dose is further increased by another 50 mg a day to 150 mg. Some doctors may even add another fertility medication such as human menopausal gonadotropin (Pergonal) in the next cycle. Side effects are likely increased at higher doses. For example, if the dose of clomiphene is too high, the uterine lining may not develop properly, which decreases the chance of implantation.
Some doctors increase the daily dose up to 250 mg a day, though this is not recommended by the drug's manufacturers.