If no egg release than we use oral agents for induction of ovulation like Letroz/ Clomiphene or Tamoxifene? But when to initiate the ovulatory drugs and how to monitor top achieve optimum or to increase the efficacy of CC/Letroz??

 If no egg release than we use oral agents for induction of ovulation like Letroz/ Clomiphene or Tamoxifene? But when to initiate the ovulatory drugs and how to monitor top achieve optimum or to increase the efficacy of CC/Letroz?? How to monitor a cycle of induction of ovulation if there is no financial constraint and couple and doctor both are dedicated:-The effectiveness and safety of Ovulation induction with oral drugs are increased: No arbitrary day of initiation of CC/Letroz!! If the starting day is determined , by the following parameters: A) not by day of period but by  menstrual day 3 estradiol and progesterone levels, if the initial dose is determined by B) body weight and C) and if preovulation follicular and endometrial response (Sonographic metrics)are monitored by ultrasound.

D) Estimate day 21 Progesterone. (Midluteal progesterone level, E) This, may I call it harassment of the couple, wife in particular is becoming more relevant as many cases husband is employed away from home town. This strict & rigid text book monitoring will help him to come home from workplace. Do members agree with this protocol of strict to the point of rigid monitoring?

 Additionally, the day and time of IUI or timed intercourse can be regulated to fit patient and clinic schedules by triggering ovulation with HCG when the preovulatory ultrasound and estradiol level indicate that follicle development is sufficiently advanced. We must be aware that we know today many things of human reproduction but not everything. Effective ovulation induction warrant safety of woman concerned and demands love not money. Both doctor and couple has to weigh and believe that safe monitoring demands science, love, courtesy, hard work and not to consider money. Our views please-Feasibility or any objection social, economical.

    What went wrong, doctor???? Was doctors expectation in ovulation induction was wrong??  . The doctor who is in charge of CC, Letroz and TMX (Tamoxifene) ovulation induction if the induction cycle fails after all hope and faith on doctor and team members declare your induced cycle is futile I am sorry flight is delayed. Have he or she ever think what went wrong with induction? Was doctors expectation was wrong?? Will couple and neighbors loose faith on doctor?? Let us face the facts in the light of science. Require serum estradiol levels ≥ 50 pg/mL to be effective. Why progesterone assay?? Reason?? Is it not a wide ball?? Unnecessary expenses!!! Ipsilateral follicle development is inhibited when the serum progesterone level is ≥ 0.9 ng/mL AS such  Initiating Ovulation induction  with CC , Letrozole or TMX (not to speak of Gonadotropins or  IUI or ART cycle with long down regulation) before these levels are attained will result in no or reduced follicle development. Admittedly, not all time planes lands in right time neither train arrives destination at exact schedule Serum levels usually reach these parameters on the third menstrual cycle day, but may require seven days or longer in patients with PCOS or persistent corpus luteum cysts. Serum estradiol levels normally double every two days, and progesterone levels normally decrease 50% per day during the early follicular phase of the cycle, and do not need to be rechecked unless they would require more than three days to reach the level required to start. Delaying the start of CC or TMX until hormone levels are in the desired range will increase the chance of successful stimulation. Take home message there is undeniable evidence that not only in IUI ore ART cycles. Even in   CC/Letroz cycle costly and harassing, you may call it, the use of estradiol and progesterone levels is helpful is initiating the starting day.