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Clomiphene Citrate

Clomiphene citrate (CC, Clomid, Serophene) is often the first fertility drug that couples come in contact with. It is (relatively) inexpensive as fertility drugs go, it is easily taken (orally rather than by injection) and it is the first line drug used for ovulation induction in patients with PCOS and other ovulatory disorders. It has been used for patients with luteal phase defect. It can also be used to assess ovarian reserve or, in other words, the likelihood that a woman's ovaries can still produce viable eggs. Clomid is not useful for women whose ovaries have reached the end of their working life.

How does it work?

Clomid is actually quite a potent and somewhat complicated medication. It is capable of reacting with all of the tissues in the body that have estrogen receptors. These tissues include hypothalamus, pituitary, ovary, endometrium, vagina, and cervix. Clomid influences the way that the four hormones required for ovulation, GnRH, FSH, LH and estradiol, relate and interrelate. While we do not completely understand the mechanisms by which this drug works, in essence it appears that Clomid fools the body into believing that the estrogen level is low. This altered feedback information causes the hypothalamus (an area of the brain) to make and release more gonadotropin releasing hormone (GnRH) which in turn causes the pituitary to make and release more FSH and LH. More follicle stimulating hormone and more luteinizing hormone should result in the release of one or more mature eggs - ovulation.

How is it taken?

When used for ovulation induction, Clomid is taken orally for approximately five days early in the menstrual cycle. Depending upon your clinic protocol this may start as early as day 3 or as late as day 5. It is important to remember that the first day of the menstrual cycle is the first day of normal bleeding, not spotting. Most women begin with an initial dose of one tablet (50 mg.) per day. This dose may be increased by your physician in subsequent cycles if pregnancy does not occur. Once ovulating, most pregnancies occur in the first 6 cycles of treatment. Clomid is said to be able to induce ovulation in as much as 85% of the women who use it, though only half of those will actually become pregnant. Most authorities agree that continuing for more than 6 ovulatory cycles in not likely to increase the chances of success. At many clinics a pelvic examination or ultrasound is done each cycle shortly before starting on CC in order to determine if there are any ovarian or uterine abnormalities. Approximately 5% of women using Clomid will develop an ovarian cyst at some time during their treatment period. These cysts are benign and will usually resolve spontaneously without any treatment, but may cause discomfort. If you are using Clomid and do not have a menstrual period by cycle day 35, you may have failed to ovulate or you may be pregnant! In either event you need to schedule a visit to your doctor to ascertain what is happening. If you are not pregnant, your doctor may prescribe other medications to help bring on your period. Extended luteal phases (late periods, long cycles) are not uncommon on Clomid.

What are the side effects of Clomiphene?

Twin pregnancies may occur in as many as 5% of the women who use Clomid. Triplet pregnancies are far more rare. Other reported adverse effects include ovarian enlargement 13.6%,Vasomotor Flushes 10.4%, abdominal or pelvic discomfort, distention or bloating 5.5%, nausea and vomiting 2.2%, breast discomfort 2.1%, visual symptoms (blurred vision, lights, floaters, waves, unspecified visual complaints, photophobia, diplopia, scotoma, etc.) 1.5%, headache 1.3% and abnormal uterine bleeding (intermenstrual spotting, menorrhagia)1.3%. Although there has been much talk about the relationship of clomiphene (and other fertility drugs) to ovarian cancer the vast majority of the evidence now seems to point at infertility itself, rather than the use of fertility drugs as being the primary explanation for the slightly increased incidence of reproductive cancers in the infertility population. (See recent discussion on our boards.) Clomid has been used to induce ovulation for more that thirty years. There is not any evidence that it causes an increase in congenital abnormalities or birth defects in children. It is not associated with an increase in premature labor or in other complications of pregnancy.