CLOMIDInfertility Treatment Drug since the 1960s
Clomid (aka Clomiphene Citrate, Serophene, Cloramifen) is widely used in infertility and has helped millions of women ovulate. It is a proven fertility drug discovered back in the 1960s and acts as a selective estrogen receptor modulator (SERM). This means that it attaches to receptors generally reserved for estrogen. The main effect is to increase the Follicle Stimulating Hormone (FSH) levels naturally. The increased FSH levels directly stimulate the ovary to mature and ovulate eggs. It can be used for ovulation induction alone or in combination with other infertility treatments like IUI and IVF.
Are you the right candidate for Clomid Treatment?Women with ovulatory dysfunction are ideal candidates for Clomiphene therapy. These are women who do experience irregular periods. Some women experience no menstrual periods for months. Most of these women suffer from Polycystic Ovarian Syndrome (PCOS). Success rates are highest when used to restore ovulation in PCOS patients. When applied correctly, it is an advantageous infertility drug that is simple, inexpensive, and effective. However, recently, Letrozole has replaced Clomiphene as the first-line drug for polycystic ovary syndrome patients due to an increased live birth rate.
Who should take it?Clomiphene cycles are often prescribed because of the low cost. Some physicians prescribe it without considering the individual circumstances of infertility. While some women with fertility problems will benefit from such random administration, many might only experience side effects! Clomiphene is quite inefficient in women who have regular cycles and no problems ovulating eggs. Some benefits might exist at a higher dose (100-150 mg daily). At a higher dose, Clomid can induce the ovary to mature multiple eggs in a single menstrual cycle. During such superovulation, a woman can ovulate multiple eggs compared to only a single egg during a natural period. Higher doses of Clomiphene should only be taken when monitored by ultrasound and might cause some side effects. During superovulation, the chance of multiples (typically twins but rarely triplets) goes up. Unfortunately, many general practitioners do not perform ovarian ultrasound monitoring and only prescribe Clomiphene at a very low (and inefficient) 50 mg dose!
What about the Clomid side effects?A quite common side effect is the thinning of the endometrial lining during therapy. This can become a problem once the embryo is ready to attach to the endometrial lining. Therefore, it is essential to monitor Clomid cycles with ultrasound and measure the endometrial thickness. If the endometrial lining is found to be thinned out, we recommend avoiding this treatment. In some cases, additional vaginal estradiol can help restore the endometrial thickness. Switching to an alternative follicle-stimulating medication might alleviate this side effect.We frequently see women given low doses of Clomiphene citrate that do not induce the growth of multiple eggs but thin out the endometrial stripe. In such cases, the woman is actually worse off than in a natural menstrual cycle. She did not gain any additional eggs and has only thinned out the endometrial lining. Patients not monitored with an ultrasound might be unaware of this side effect. Therefore, every serious fertility expert will always perform a transvaginal ultrasound in a Clomid cycle. We always want to document how many follicles developed and the endometrial thickness.Common Clomid side effects include hot flashes, headache, blurry vision, mood swings, and can induce a change in cervical mucus. Clomiphene works directly on the pituitary gland and also affects many tissues with estrogen receptors. This is in contrast to injectable gonadotropins like Gonal-F that targets primarily just the ovary. Therefore many patients will notice changes in their body during the Clomid cycle. Fortunately, none of these is a long-lasting side effect, and there are no long-term effects. While some concern was raised regarding ovarian cancer, there is no conclusive evidence that considerate use of Clomifen increases the risk.Rarely, a patient can develop ovarian hyperstimulation syndrome (OHSS). Such a condition needs immediate medical attention and is considered a severe side effect. Usually, these patients have high AMH levels. Another side effect is ovarian cysts that can occur weeks after treatment! The cysts are often discovered once we see the patient for another treatment cycle start or in cases of pelvic pain. The reason behind this is that Clomiphene may remain active in the woman's body for several weeks. The ovaries may continue to stimulate, increasing the occurrence of ovarian cysts.
Does the response to Clomid vary?Yes! We sometimes see extreme responses, and we have had patients develop too many eggs - as high seven or eight eggs! Some patients develop the hyperstimulation syndrome and ovarian enlargement and need immediate care by a fertility specialist. While higher-order multiples are rare, patients have conceived triplets using Clomifene alone. High responders might be better served with undergoing IVF instead of IUI.Fortunately, the majority of patients develop 2-3 follicles with the right dose. Some patients with very severe PCOS show resistance to the medication. While very useful in patients who do not ovulate eggs, some patients show no response because their condition is too severe. Another frequently used term is "Clomid resistant."These patients usually include PCOS patients with very high AMH levels. In such cases, we need to use injectable gonadotropins like Gonal-F or Follistim to restore the ovulatory cycle.
How to take Clomid?A woman can start taking Clomid tablets between cycle day three and cycle day 5. Each tablet contains 50mg of Clomiphene Citrate. Typically patients take 1-3 tablets daily for a total of five days. The medication remains effective in the body even after all tablets are consumed since the half-life is very long. In some cases, when used as an adjunct to mini-IVF, it can be given over an extended period of time.Typically your physician will bring you back after about a week to evaluate the ovarian follicles with an ultrasound. You might be instructed to test for natural ovulation or might use an ovulation-inducing trigger shot instead. You will be notified to have timed intercourse or undergo intrauterine insemination. Your doctor might monitor your progesterone blood level. A pregnancy test is done about 14 days after ovulation.
Are there any alternatives to Clomid?Yes, there are other oral medications that can stimulate the ovaries by the gonadotropin-releasing effect. Some of them are Letrozole and Tamoxifen. They can be utilized instead of Clomid. In-fact, Letrozole has replaced Clomid as the first-line agent for ovulation induction in PCOS patients due to better success rates. A more potent alternative is injectable fertility drugs, typically used in IVF.
Where to get Clomid?Your gynecologist or fertility doctor can provide you with a prescription. Sometimes a general health practitioner can also provide you an order. We recommend seeing a fertility specialist whenever possible. Their expertise in female infertility can ensure that Clomid is the appropriate treatment for your condition. Fertility clinics are the best places to obtain and monitor Clomid treatment due to their highest expertise in infertility.Clomid is still considered low-tech fertility treatment and is typically a covered benefit by any primary health insurance, including HMO plans like Kaiser Permanente. Kaiser patients with infertility issues can read more about the Kaiser Permanente fertility treatment options here. Patients that pay Clomid out of pocket spend about $50 or less.
Are office visits necessary?Transvaginal ovarian ultrasound monitoring is the best way to evaluate ovarian physiology. In limited circumstances, a diagnosis of ovulatory dysfunction can be made by patient history and presenting symptoms in a remote consultation with an experienced reproductive endocrinologist. Blood tests can confirm this diagnosis, and Clomid therapy can be initiated remotely. Monitoring ovulation at home might be a challenge since a vast majority of patients with ovulatory dysfunction suffer from PCOS and might have increased baseline Luteinizing Hormone (LH) levels. Thus, detecting ovulation becomes somewhat tricky, but a patient can be guided on how to correctly interpret the results and, in some cases, use diluted urine specimens to improve the specificity of urine strip ovulatory tests. Modern urinary fertility monitors further detect Estrone-3-glucuronide, and this can alert the Clomid user of rising estrogen levels and a developing follicle. However, no home monitor can provide information on the number of developing follicles or thickness of the uterine lining.In general, unmonitored Clomid therapy might only be justified with patients with irregular or absent periods. Patients with regular periods seeking Clomid therapy are strongly encouraged to have monitored cycles only!
What about male infertility?Clomid can be used for male infertility. The dose is typically 25-50 mg per day and requires close monitoring of FSH, LH, Testosterone. It can be combined with HCG or used alone. It is vital to avoid hyperstimulation of the testicles, and you need an experienced fertility urologist or fertility specialist for a consultation.
How to improve Clomid Success Rates?Any fertility medication will only be successful if it can adequately address the underlying problem. If appropriately used, particularly in patients with anovulation, Clomid therapy can be hugely rewarding with a high pregnancy rate. If used randomly with no clear rationale, it might induce ovarian cysts and further complicate female infertility treatments. Timing the ovulation with either ovulatory predictor kits (OPK) or artificial ovulation trigger in combination with timed intercourse or IUI can further improve the treatment success rates. It is best to contact an experienced reproductive endocrinologist who can provide you with guidance and proper assessment and ensure your Clomid Therapy Success.