Traditional Clomiphene Citrate Administration vs. Stair-step Approach

Inclusion Criteria: * Ovulatory dysfunction as evidenced by mid-luteal progesterone less then 3ng/dL, non-biphasic basal body temperature charting, or menstrual history of cycles \> 35 days. * Female patients 18 to 45 years old * Six months or greater of unprotected intercourse without pregnancy. * Normal TSH and prolactin serum levels * Semen analysis of male partner with \> 15 million motile sperm on semen analysis. * NOTE: Must be willing to travel to the Oklahoma City area for treatment. Exclusion Criteria: * Failure to spontaneously menstruate or to menstruate following progestin administration * Allergy or intolerance to the side effects of clomiphene citrate, hCG (human chorionic gonadotropins), or medroxyprogesterone acetate (Provera). * Known anatomical defect affecting the uterine cavity including submucosal fibroids or endometrial polyps. * Know tubal hydrosalpinx or risk factors for tubal obstruction * Known liver dysfunction * Known or suspected androgen secreting tumor, cushings disease, or adrenal hyperplasia (congenital or adult onset) * Ovarian cyst \> 20mm or endometrial lining \>6 mm on trans-vaginal baseline ultrasound. * Stage III or IV endometriosis * Decreased ovarian reserve as evidenced by antral follicle count less than 6 by Transvaginal ultrasound or a cycle-day-3 serum FSH of \> 10 uIU/ml. * Positive HIV in either the female patient or her partner.